Abstract 13231: Bypassing the Emergency Department is Associated with Faster Reperfusion in Patients with Pre-Hospital ST-Segment Elevation: Findings from the ACTION Registry®-GWTG™
Background: Among patients with pre-hospital diagnosis of ST-Segment Elevation Myocardial Infarction (STEMI), emergency medical services (EMS) transport from the field directly to the catheterization laboratory (thereby bypassing the emergency department [ED]) can potentially shorten time to reperfusion.
Methods: We studied 15,092 patients with a pre-hospital diagnosis of STEMI from the ACTION Registry-GWTG presenting via EMS to 395 United States hospitals for primary percutaneous coronary intervention (PCI) between January 2007 and March 2011. Treatment time intervals were compared between patients evaluated first in the ED (ED first) and those transported directly from the field to the catheterization lab (ED bypass).
Results: Evaluation in the ED occurred in 13,515 (89.5%) patients, while ED was bypassed in 1,577 (10.5%) patients. During working hours, ED bypass rate was 18.1%, compared with 4.3% during off-hours. Median frequency of ED bypass at the hospital level was 3.5% (IQR 0%, 14%). Patients evaluated in the ED first were at higher risk with greater frequency of heart failure and cardiogenic shock on presentation, and cardiac arrest and/or need for intubation prior to PCI (Table). Median time from ED arrival to catheterization lab arrival was 31 (IQR 20, 43) minutes in the ED first group. Hospital arrival to device activation and first medical contact to device activation times were significantly shorter in ED bypass patients. First medical contact to device time ≤90 minutes was achieved more frequently in ED bypass patients (82.1% vs. 57.5%, p<0.0001).
Conclusions: The ED is infrequently bypassed at United States hospitals in patients with pre-hospital diagnosis of STEMI. Bypassing the ED is associated with shorter first medical contact to device times by approximately 20 minutes. Further exploration of patient, EMS, ED work flow, and catheterization lab factors is needed to develop ED bypass protocols for appropriate patients.
- © 2012 by American Heart Association, Inc.