Abstract 11589: Prehospital Evaluation and Economic Analysis of DIfferent Coronary Syndrome Treatment Strategies (PREDICT)- A Prospective Cohort Study
Objective: International guidelines recommend the use of prehospital 12-lead ECG (PH12-lead) to identify acute ST-segment elevation myocardial infarction (STEMI) and improve time to reperfusion; however, not all communities have access to PH12-lead and the impact on STEMI care is unknown.
Methods: PREDICT was a prospective population-based cohort study in Ontario, Canada comparing PH12-lead versus standard prehospital rhythm monitoring (PH3-lead) in adult patients with chest pain (> 30 minutes and < 6 hours) receiving ≥ 2 nitroglycerin. The primary outcome measure was the reperfusion rate within target time intervals (door to balloon time < 90 min or door to needle time < 30 min). The two cohorts were stratified by eligibility for bypass of destination hospital and transport to the nearest receiving percutaneous coronary intervention (PCI) centre (defined as transport time ≤ 60 min). Fisher exact tests evaluated differences in proportions and time intervals were compared using Wilcoxon test of medians.
Results: Of the 9026 treated chest pain patients, 9018 (99.9%) had location data. Of these, 643 had STEMI (7.1%) on PH12-lead or first ECG in-hospital (PH 3-lead). 446 STEMIs were bypass eligible (335 PH12-lead and 111 PH3-lead) and 197 STEMIs were bypass ineligible (104 PH12-lead and 93 PH3-lead). There were no differences in mean age or gender distribution except males were more common in the bypass ineligible group managed with PH12-lead; 73% vs. 51% p=0.01. STEMI patients managed with PH12-lead were more likely to receive reperfusion when compared to STEMI patients managed with PH3-lead (bypass eligible OR 2.95 [95% CI 1.8, 4.8 p<0.001]; bypass ineligible OR 2.0 [95% CI 1.1, 3.7 p=0.016]). STEMIs managed with PH12-lead were more likely to receive reperfusion within the target time intervals (PCI in bypass eligible OR 9.4 [95% CI 3.6, 25.9 p<0.001]; fibrinolysis in bypass ineligible OR 4.0 [95% CI 1.2, 14.3 p=0.024]).
Conclusion: STEMI patients who received PH12-lead were more likely to receive timely reperfusion. STEMI patients managed with PH3-lead were less likely to receive any reperfusion and the time interval was delayed. Implementation of PH12-lead in communities without this capability may correct for this inequality of access to timely care.
- © 2013 by American Heart Association, Inc.