Abstract 2837: Impact of Paramedic Initiated Pre-hospital Cardiac Catheterization Lab Activation for Acute ST-Segment Elevation Myocardial Infarction Patients on Off-Peak Door-to-Balloon Times
Background: Achieving and exceeding a door-to-balloon time (DBT) of 90 minutes with acute ST-segment elevation myocardial infarction (STEMI) patients receiving primary percutaneous coronary intervention (PCI) is challenging - even more so during off-peak hours (17:00 – 06:59 M-F, Weekends) compared to on-peak hours (07:00 –16:59, M-F). Evidence continues to mount supporting the need to maximally reduce DBT for all STEMI patients. Recognizing an acute STEMI in the pre-hospital setting by paramedics could reduce DBT by early mobilization of the cardiac catheterization team in off-peak settings.
Methods: From 05/06 to 04/09 we analyzed the prospective observational registry of STEMI patients at our hospital, a tertiary cardiovascular center in a large urban city, for patients presenting to our emergency department (ED) as paramedic initiated pre-hospital cardiac catheterization lab activation (PCLA), by ambulance without PCLA and by self/family evaluating DBT at both on-peak and off-peak times.
Results: 263 patients presented to our ED as STEMI patients, with a median DBT (mDBT) 58 minutes (min). 126 presented during on-peak times with mDBT 46 min while 137 were off-peak, mDBT 68 min (p<0.0001). The mDBT for PCLA patients (n=105) was 43 min, 33 min on-peak (n=56) and 49 min off-peak (n=49) (p<0.0001). Patients arriving by ambulance without PCLA (n=80) had a mDBT of 74.5 min, 68 min on-peak (n=37) and 79 off-peak (n=43) (p=0.089). Patients presenting by self/family (n=78) had a mDBT of 73.5 min, 61 min on peak (n=33) and 76 min off-peak (n=45) (p=0.033). The reduction in DBT for PCLA compared to both ambulance non-PCLA and self/family arrival patients was statistically significant for on-peak (33 min vs. 68 min and 61 min - p<0.0001 and p<0.0001 respectively) and off-peak (49 min vs. 79 min and 76 min - p<0.0001 and p<0.0001 respectively) times.
Conclusions: PCLA can provide a clinically and statistically significant improvement in DBT for PCLA patients compared to ambulance arrival non-PCLA and self/family arrival STEMI patients can be achieved in not only on-peak and but also off-peak times.