Premium
Impact of pre‐hospital electrocardiograms on time to treatment and one year outcome in a rural regional ST ‐segment elevation myocardial infarction network
Author(s) -
Kahlon Talwinder S.,
Barn Kulpreet,
Akram Mian Muhammad Ali,
Blankenship James C.,
BowerStout Cinde,
Carey Dave J.,
Sun Haiyan,
Tompkins Weber Karen,
Skelding Kimberly A.,
Scott Thomas D.,
Green Sandy M.,
Berger Peter B.
Publication year - 2017
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.26567
Subject(s) - medicine , myocardial infarction , elevation (ballistics) , cardiology , st segment , outcome (game theory) , electrocardiography , st elevation , emergency medicine , medical emergency , geometry , mathematics , mathematical economics
Background Pre‐hospital electrocardiograms (ECGs) are believed to reduce time to reperfusion in ST Segment Elevation Myocardial Infarction (STEMI) patients. Little is known of their impact on clinical outcomes in a rural setting. Geisinger regional STEMI network provides percutaneous coronary intervention (PCI) care to over a 100‐mile radius in rural central Pennsylvania. Methods A retrospective analysis identified 280 consecutive STEMI patients treated with PCI between 1/1/09 and 8/31/11. Comparison between two STEMI groups was performed: 205 patients who were taken by the emergency medical system (EMS) to the nearest hospital (a non‐PCI center), underwent an ECG revealing a STEMI, and were transported immediately to Geisinger Medical Center (GMC) for PCI (transfer group) versus 75 patients in whom a pre‐hospital ECG was obtained and who were transported by EMS directly to Geisinger for PCI, bypassing the nearest hospital that did not perform PCI (the pre‐hospital ECG group). Results Analysis of baseline characteristics revealed that the pre‐hospital ECG cohort was older (65 vs. 60 years); had a higher percentage of previous myocardial infarctions (MI) (28% vs. 15%), heart failure (11% vs. 4%), and prior PCI (23% vs. 13%; p < 0.05 all comparisons). Median time from EMS contact to pre‐hospital ECG in the pre‐hospital ECG group was 5 minutes; from pre‐hospital ECG to the GMC ED was 34 minutes. Median time from first medical contact (EMS contact) to reperfusion (device activation) was 79 versus 157 minutes ( P < 0.001), respectively in pre‐hospital ECG vs. transfer groups. Mortality in the two groups at 1 year was 4.1% in the pre‐hospital ECG group versus 8.3% in the transfer group ( P ‐value = 0.34). After adjusting for the difference in age between the two groups, the 62% reduction in 1 year mortality associated with having obtained a pre‐hospital ECG was still not statistically significant ( P ‐value = 0.19). Conclusion In a rural regional STEMI network, pre‐hospital ECGs decreased time from first medical contact to reperfusion by 50% and were associated with an excellent clinical outcome at 1 year. © 2016 Wiley Periodicals, Inc.