Abstract 19586: Changing the Paradigm in STEMI from D2B to R2R: Results of the STAT-MI Trial
Background: In the treatment of STEMI with primary PCI the goal of door to balloon (D2B) times is less than 90 minutes. However D2B times fail to take into account pre-hospital transfer time which begins once a STEMI patient has been recognized in the field by health care personnel. We previously reported our initial experience with our STAT-MI network and its impact on shortening D2B times. We now highlight the impact of our network on the time interval between first medical contact and first intervention or “Recognition to Reperfusion” (R2R) times.
Methods: The STAT-MI communications network was developed to transmit 12-lead ECGs from the field directly to smart phones worn by cardiologists facilitating direct triage of patients from the field to the cardiac catheterization lab for primary PCI. Demographics, laboratory and time interval data of STAT-MI patients were prospectively collected and compared to concurrent control patients who presented with STEMI through non-STAT-MI network pathways. Recognition time was defined as the time of first medical contact by either EMS or emergency department staff.
Results: From June 2006 through October 2009, 92 patients presented via the STAT-MI network, and 50 patients presented through non-STAT-MI network pathways. Baseline clinical and demographic variables were similar in both groups. STAT-MI network patients had significantly shorter R2R times compared with non-STAT-MI network patients (101.2± 33.6 vs 214 ± 146.8 min p=0.0008). STAT-MI network patients as compared with controls had significantly shorter recognition-to-ECG times (13.3±8.6 vs. 71.9±76.7 min p<0.0001) and shorter ECG-to-cardiology notification times (6.8±5.9 vs. 39.3± 63.5 min p<0.002) demonstrating that the delays that occur at multiple intermediary steps are eliminated by the STAT-MI network.
Conclusions: Beyond shortening D2B times our STAT-MI network significantly shortened R2R times demonstrating the ability of our network to integrate pre-hospital care with hospital based therapy in STEMI patients. Quality care assessments of health care systems should evaluate R2R times as a more accurate reflection of the quality of health care delivery in the treatment of STEMI patients.
- © 2010 by American Heart Association, Inc.