Document Detail


Association between prehospital time intervals and ST-elevation myocardial infarction system performance.
MedLine Citation:
PMID:  20876439     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Among individuals experiencing an ST segment-elevation myocardial infarction, current guidelines recommend that the interval from first medical contact to percutaneous coronary intervention be ≤90 minutes. The objective of this study was to determine whether prehospital time intervals were associated with ST-elevation myocardial infarction system performance, defined as first medical contact to percutaneous coronary intervention. METHODS AND RESULTS: Study patients presented with an acute ST-elevation myocardial infarction diagnosed by prehospital ECG between May 2007 and March 2009. Prehospital time intervals were as follows: 9-1-1 call receipt to ambulance on scene ≤10 minutes, ambulance on scene to 12-lead ECG acquisition ≤8 minutes, on-scene time ≤15 minutes, prehospital ECG acquisition to ST-elevation myocardial infarction team notification ≤10 minutes, and scene departure to patient on cardiac catheterization laboratory table ≤30 minutes. Time intervals were derived and analyzed with descriptive statistics and logistic regression. There were 181 prehospital patients who received percutaneous coronary intervention, with 165 (91.1) having complete data. Logistic regression indicated that table time, response time, and on-scene time were the benchmark time intervals with the greatest influence on the probability of achieving percutaneous coronary intervention in ≤90 minutes. Individuals with a time from scene departure to arrival on cardiac catheterization laboratory table of ≤30 minutes were 11.1 times (3.4 to 36.0) more likely to achieve percutaneous coronary intervention in ≤90 minutes than those with extended table times. CONCLUSIONS: In this patient population, prehospital timing benchmarks were associated with system performance. Although meeting all 5 benchmarks may be an ideal goal, this model may be more useful for identifying areas for system improvement that will have the greatest clinical impact.
Authors:
Jonathan R Studnek; Lee Garvey; Tom Blackwell; Steven Vandeventer; Steven R Ward
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Publication Detail:
Type:  Journal Article     Date:  2010-09-27
Journal Detail:
Title:  Circulation     Volume:  122     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-10-12     Completed Date:  2010-11-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1464-9     Citation Subset:  AIM; IM    
Affiliation:
Carolinas Medical Center, Center for Prehospital Medicine, Charlotte, NC 28232, USA. jonst@medic911.com
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MeSH Terms
Descriptor/Qualifier:
Angioplasty, Balloon, Laser-Assisted
Benchmarking / standards*
Electrocardiography*
Emergency Medical Services / standards*
Female
Humans
Logistic Models
Male
Middle Aged
Myocardial Infarction / therapy*
North Carolina
Outcome Assessment (Health Care)
Retrospective Studies
Time Factors
United States
Comments/Corrections
Comment In:
Circulation. 2010 Oct 12;122(15):1443-5   [PMID:  20876431 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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