Document Detail

Causes of Delay and Associated Mortality in Patients Transferred With ST-Segment-Elevation Myocardial Infarction.
MedLine Citation:
PMID:  21931079     Owner:  NLM     Status:  Publisher    
Background-Regional ST-segment-elevation myocardial infarction systems are being developed to improve timely access to primary percutaneous coronary intervention (PCI). System delays may diminish the mortality benefit achieved with primary PCI in ST-segment-elevation myocardial infarction patients, but the specific reasons for and clinical impact of delays in patients transferred for PCI are unknown.Methods and Results-This was a prospective, observational study of 2034 patients transferred for primary PCI at a single center as part of a regional ST-segment-elevation myocardial infarction system from March 2003 to December 2009. Despite long-distance transfers, 30.4% of patients (n=613) were treated in ≤90 minutes and 65.7% (n=1324) were treated in ≤120 minutes. Delays occurred most frequently at the referral hospital (64.0%, n=1298), followed by the PCI center (15.7%, n=317) and transport (12.6%, n=255). For the referral hospital, the most common reasons for delay were awaiting transport (26.4%, n=535) and emergency department delays (14.3%, n=289). Diagnostic dilemmas (median, 95.5 minutes; 25th and 75th percentiles, 72-127 minutes) and nondiagnostic initial ECGs (81 minutes; 64-110.5 minutes) led to delays of the greatest magnitude. Delays caused by cardiac arrest and/or cardiogenic shock had the highest in-hospital mortality (30.6%), in contrast with nondiagnostic initial ECGs, which, despite long treatment delays, did not affect mortality (0%). Significant variation in both the magnitude and clinical impact of delays also occurred during the transport and PCI center segments.Conclusions-Treatment delays occur even in efficient systems for ST-segment-elevation myocardial infarction care. The clinical impact of specific delays in interhospital transfer for PCI varies according to the cause of the delay.
Michael D Miedema; Marc C Newell; Sue Duval; Ross F Garberich; Chauncy B Handran; David M Larson; Steven Mulder; Yale L Wang; Daniel L Lips; Timothy D Henry
Related Documents :
25415149 - Periprocedural ischaemia during recanalisation of chronic total coronary occlusions: th...
7863289 - Reperfusion ventricular fibrillation and electric countershocks during coronary artery ...
20876969 - Numerically simulated cardiac exposure to electric current densities induced by taser x...
18687249 - No benefit from defibrillation threshold testing in the scd-heft (sudden cardiac death ...
25411819 - Reduction of isoproterenol-induced cardiac hypertrophy and modulation of myocardial con...
8473649 - Ventricular fibrillation in patients without significant structural heart disease: a mu...
12127379 - Transcardiac gradient of soluble adhesion molecules predicts progression of coronary ar...
24967059 - Values of troponin t and myoglobin predictive of non-cardiac ischemia in rats.
12655159 - Increased serum matrix metalloproteinase-1 concentration predicts advanced left ventric...
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-9-19
Journal Detail:
Title:  Circulation     Volume:  -     ISSN:  1524-4539     ISO Abbreviation:  -     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-9-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms

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

Previous Document:  Intrathoracic Impedance Monitoring, Audible Patient Alerts, and Outcome in Patients With Heart Failu...
Next Document:  Comparison of transplacental treatment of fetal supraventricular tachyarrhythmias with digoxin, flec...