Abstract 16090: EMS Transport of STEMI Patients Shortens Ischemic Time and is Associated With a Higher Risk Population: Results from the ACTION Registry.
Background: Continued quality improvement efforts have had a positive impact on Door to Balloon (D2B) times for STEMI patients. Pre-hospital ischemic time has historically received little attention. Several recent studies have highlighted the critical importance of restoring reperfusion to ischemic myocardium within the first 90-120 minutes. With the growing understanding of the importance of reducing total ischemic time, opportunities to improve the prehospital component of STEMI care must be explored.
METHODS: We queried the American College of Cardiology's National Cardiovascular Data Registry (NCDR) Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry-Get With The Guidelines (GWTG) Database for STEMI patients who initially presented to facilities capable of Primary PCI and compared pre-hospital ischemic time (PHIT) defined as symptom onset to hospital arrival, first medical contact time (FMCT) and D2B times for EMS transports (EMS-T) vs. Self transports (Self-T). Patients were excluded if symptom onset or FMCT was not recorded.
RESULTS: 37,715 patients from 412 sites between July 2008 and Dec 2010 were analyzed. 22,980 (61%) were EMS-T and 14,735 (39%) were Self-T. Median symptom onset to hospital arrival was significantly shorter for EMS-T versus Self-T (89 min (SD 201 min) vs. 118 min (SD 295 min) p <.001). 65% of EMS-T arrived at the destination hospital <2 hrs from symptom onset compared with 52% of Self-T (p <.001). For EMS-T, median symptom onset to FMCT was 53 min (SD 198 min) and FMCT was <1 hour in 56% and <2 hours in 75% of patients. Median first medical contact to hospital arrival time was 31 min (SD 25 min). D2B was 56 min (SD 28 min) for EMS-T and 70 min (SD 37 min) for Self-T (p<.001). Rates of shock (10.7% vs. 3.5%; p < .001), heart failure (9.9% vs. 6.3%; p < .001) and mortality (7.2% vs. 2.4%; p< .001) were all significantly higher in the EMS-T group.
CONCLUSIONS: Pre-hospital ischemic time is significantly shorter for patients who are transported by EMS. Despite more rapid access to care, these patients had a higher rate of in-hospital shock, heart failure and death. This strongly suggests that STEMI patients that access the health care system via 911 represent a higher risk cohort than those that self-transport.
- © 2011 by American Heart Association, Inc.