Abstract 14164: Impact of Pre-Hospital Electrocardiograms and Mode of Patient Presentation on In-Hospital Mortality in a Regional Model of ST-Elevation Myocardial Infarction Care
Background Pre-hospital electrocardiograms (pECGs) reduce door-to-balloon times in the treatment of ST-elevation myocardial infarction (STEMI). However, their clinical impact within a regionalized system for treatment of STEMI has not been well described in a “real world” population. We describe the routine use and clinical impact of pECGs on in-hospital mortality within a regional model of STEMI care.
Methods This is a retrospective cohort study involving all patients (n = 348) who received primary percutaneous coronary intervention (PPCI) for the treatment of STEMI between May 2007 and May 2009 in the Vancouver Coastal Health Authority. The primary endpoint is the comparison of in-hospital mortality between STEMI patients identified with a pECG and those who received PPCI without a pECG. Secondary endpoints include the door to balloon time (DBT) and first medical contact to balloon time (FBT) between groups.
Results In-hospital mortality differed amongst STEMI patients arriving via EHS with a pECG (5.7%) compared to those arriving via EHS without a pECG (11.9%), those arriving via inter-hospital transfer (6.3%), and those self-directed to a PPCI centre (0%, p = 0.009). pECG patients had the shortest median DBT (54 min) and FBT (81 min) compared to those patients who presented via alternate means (p < 0.001). The introduction of pECGs following the regionalization of STEMI care reduced both median DBT (78 min vs. 113 min, p < 0.001) and FBT (99 min vs. 128 min, p < 0.001). More patients arriving via EHS (± pECG) had a history of cardiovascular disease; they also had greater co-morbidities on presentation. EHS patients experienced more in-hospital cardiogenic shock when compared to other modes of presentation (13.1% vs. 4.5%, p = 0.009). EHS patients without a pECG had the highest rates of cardiogenic shock (19.6%), compared to EHS patients with a pECG (6.6%), inter-hospital transfers (6.3%), and self-directed patients (2.9%, p = 0.001).
Conclusions STEMI patients arriving via EHS have greater co-morbidities on initial presentation than patients arriving via other modes of transportation. However, the use of pECGs reduced both in-hospital mortality and in-hospital cardiogenic shock in this group, as well as reperfusion times among all groups.
- Myocardial infarction, STEMI
- Percutaneous coronary intervention
- Healthcare delivery systems
- © 2011 by American Heart Association, Inc.