Abstract 11829: Improvement in Care and Outcomes for Ambulance-Transported ST-Elevation Myocardial Infarction Patients With and Without Out-of-Hospital Cardiac Arrest: A Mission: Lifeline STEMI ACCELERATOR Study
Introduction: ST-elevation myocardial infarction (STEMI) patients with out-of-hospital cardiac arrest (OHCA) may not only benefit from timely intervention (PCI) but also from temperature management and other critical care that often is offered at a PCI-center. Relative to non-OHCA STEMI patients, those with OHCA have previously been less likely to bypass the nearest hospital to reach a cardiac center.
Methods: We reported time trends in emergency medical service (EMS) transport pattern and care of STEMI patients with and without OHCA included from ACTION®-GWTG™ hospitals (484 hospitals and 1253 EMS agencies in 16 US regions) with participation in the STEMI ACCELERATOR Mission: Lifeline (MLL) initiative between July 1st 2012 (2012Q3) and March 31st 2014 (2014Q1). Time trends by quarter were assessed using logistic regression with Generalized Estimating Equations to account for hospital clustering.
Results: Of 13,189 EMS-transported patients, 88.7% (N=11,703) were direct presenters and 10.5% (N=1,227) of these had OHCA. Among 1,486 transfer-in patients, 21.7% (N=322) had OHCA. The proportion with OHCA taken directly to a PCI-center increased from 74.7% to 83.6% between 2012Q3-2014Q1 (OR per quarter= 1.07; 95% CI=1.02-1.14), compared to an increase of 89.0% to 91.0% for non-OHCA patients (OR=1.03; 95% CI=0.99-1.07; interaction p=0.23). Proportions examined with a prehospital ECG increased in both direct presenter groups (53.9% to 61.9% for OHCA; and 73.9% to 81.9% for non-OHCA; interaction p=0.12). Of 997 direct OHCA patients treated with primary PCI, a first medical contact(FMC-)-to-device time ≤90 minutes was met for 34.5% in 2012Q3 vs. 41.8% in 2014Q1 (51.6% and 56.1% for 9352 non-OHCA direct presenters treated with primary PCI; interaction p=0.72). In-hospital mortality for primary PCI-treated patients was 29.8% for direct OHCA presenters vs. 35.9% for transfer-in OHCA patients (OR=0.76; 95% CI=0.56-1.02), compared to 4.1% vs. 5.3% for non-OHCA direct vs. transfer-in patients (OR=0.86; 95% CI=0.64-1.16; interaction p=0.49).
Conclusion: Increases in proportions with prehospital ECG, with direct transport to a PCI-center, and meeting FMC-to-device guideline-recommended goals were seen for STEMI patients with and without OHCA.
Author Disclosures: K. Kragholm: Research Grant; Significant; The Laerdal Foundation. D. Lu: None. K. Chiswell: None. H. Al-Khalidi: None. M.L. Roettig: None. M. Roe: Research Grant; Significant; Astra Zeneca, Eli Lilly & Co., Janssen Pharmaceuticals, Sanofi-Aventis, Daiichi-Sankyo, Ferring Pharmaceuticals, Familial Hypercholesterolemia Foundation. Honoraria; Modest; Amgen, Bristol Myers Squibb. Consultant/Advisory Board; Modest; Astra Zeneca, Eli Lilly & Co., Daiichi-Sankyo, Amgen, PriMed, Myokardia, Boehringer-Ingelheim. Consultant/Advisory Board; Significant; Merck & Co. J. Jollis: Research Grant; Significant; Medtronic Foundation. C.B. Granger: Research Grant; Significant; Medtronic Foundation.
- © 2016 by American Heart Association, Inc.