Abstract 9359: Effects of Pre-Hospital ECG Use and Patient Residence Distance From PCI Center on Time to Device Activation in ST Segment Elevation Myocardial Infarction: A Retrospective Analysis From the NCDR
Objective: American Heart Association guidelines recommend <90 minutes from first medical contact (FMC) to reperfusion for ST segment elevation myocardial infarction (STEMI) patients. Prehospital electrocardiograms (ECGs) reduce time to reperfusion, but the relative influence of patient distance from a percutaneous coronary intervention (PCI) center on this effect is unclear. We evaluated the relationship between patient distance from a PCI center, prehospital ECG use, and interval from FMC to device activation among patients with STEMI.
Methods: We performed a retrospective cohort study including all STEMI patients in the ACTION Registry-Get With the Guidelines from 7/1/2008 to 9/30/2012 who were transported by ground emergency medical services (EMS) to a PCI center. Patient distance was defined as the driving distance from the patient’s home zip code to the PCI center address as calculated by Google Maps. Home zip code was used as a surrogate for EMS call location. Patient distance was classified into tertiles (16.3 mi), and simple linear regression was used to characterize the interaction between prehospital ECG use and patient distance with respect to time to device activation.
Results: Of the 29,506 STEMI patients, 19,690 (67%) received a prehospital ECG. The median patient distance to PCI center was 11.0 mi among patients with a prehospital ECG and 9.9 mi among those without. Overall, a prehospital ECG reduced the FMC to device activation time by 10.9 minutes (p<0.001). This reduction in time from FMC to device was consistent across tertiles of distance (1st, median 11 minutes; 2nd, median 11 minutes; 3rd, median 10 minutes). The effect of prehospital ECG is attenuated by 0.8 minutes for every 10 mile increases in distance (interaction p=.0002). During off hours, median time from FMC to device activation was longer in each distance tertile when compared to work hours (86 vs 68, 86 vs 70, and 92 vs 77 minutes, respectively; p<0.001 for all).
Conclusion: Prehospital ECGs are commonly used among STEMI patients and reduce the time from FMC to device activation by approximately 10 minutes. Patient distance from a PCI center was not associated with this time interval, but presentation during off hours was associated with longer times.
- © 2013 by American Heart Association, Inc.