Open AccessImprovement in Care and Outcomes for Emergency Medical Service–Transported Patients With ST ‐Elevation Myocardial Infarction (STEMI) With and Without Prehospital Cardiac Arrest: A Mission: Lifeline STEMI Accelerator Study
Author(s) -
Kragholm Kristian,
Lu Di,
Chiswell Karen,
AlKhalidi Hussein R.,
Roettig Mayme L.,
Roe Matthew,
Jollis James,
Granger Christopher B.
Publication year - 2017
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.117.005717
Subject(s) - medicine , conventional pci , percutaneous coronary intervention , myocardial infarction , confidence interval , emergency medical services , odds ratio , emergency medicine , cardiology , medical emergency
Background Patients with ST‐elevation myocardial infarction ( STEMI ) with out‐of‐hospital cardiac arrest ( OHCA ) may benefit from direct transport to a percutaneous cardiac intervention (PCI) hospital but have previously been less likely to bypass local non‐ PCI hospitals to go to a PCI center. Methods and Results We reported time trends in emergency medical service transport and care of patients with STEMI with and without OHCA included from 171 PCI ‐capable hospitals in 16 US regions with participation in the Mission: Lifeline STEMI Accelerator program between July 1, 2012, and March 31, 2014. Time trends by quarter were assessed using logistic regression with generalized estimating equations to account for hospital clustering. Of 13 189 emergency medical service–transported patients, 88.7% (N=11 703; 10.5% OHCA ) were taken directly to PCI hospitals. Among 1486 transfer‐in patients, 21.7% had OHCA . Direct transport to a PCI center for OHCA increased from 74.7% (July 1, 2012) to 83.6% (March 31, 2014) (odds ratio per quarter, 1.07; 95% confidence interval, 1.02–1.14), versus 89.0% to 91.0% for patients without OHCA (odds ratio, 1.03; 95% confidence interval, 0.99–1.07; interaction P =0.23). The proportion with prehospital ECG s increased for patients taken directly to PCI centers (53.9%–61.9% for those with OHCA versus 73.9%–81.9% for those without OHCA ; interaction P =0.12). Of 997 patients with OHCA taken directly to PCI hospitals and treated with primary PCI , first medical contact‐to‐device times within the guideline‐recommended goal of ≤90 minutes were met for 34.5% on July 1, 2012, versus 41.8% on March 31, 2014 (51.6% and 56.1%, respectively, for 9352 counterparts without OHCA; interaction P =0.72). Conclusions Direct transport to PCI hospitals increased for patients with STEMI with and without OHCA during the 2012 to 2014 Mission: Lifeline STEMI Accelerator program. Proportions with prehospital ECG s and timely reperfusion increased for patients taken directly to PCI hospitals.