| The Impact of a Statewide Pre-Hospital STEMI Strategy to Bypass Hospitals without Percutaneous Coronary Intervention Capability on Treatment Times. | |
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MedLine Citation:
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PMID: 23275382 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND: The ultimate treatment goal for ST-segment elevation myocardial infarction (STEMI) is rapid reperfusion via primary percutaneous intervention (PCI). North Carolina has adopted a statewide STEMI referral strategy that advises paramedics to "bypass" local hospitals and transport STEMI patients directly to a PCI-capable hospital, even if a non-PCI-capable hospital is closer. METHODS AND RESULTS: We assessed emergency medical services (EMS) adherence to this STEMI protocol, as well as subsequent associations with patient treatment times and outcomes by linking data from the ACTION Registry-GWTG and a statewide EMS data system from 06/2008-09/2010 for all STEMI patients. Patients were divided into those: (1) transported directly to a PCI hospital, thereby bypassing a closer non-PCI hospital; and (2) first taken to a closer non-PCI center and later transferred to a PCI hospital. Among 6010 STEMI patients, 1288 were eligible and included in our study cohort. Of these, 826 (64%) were transported directly to a PCI facility, whereas 462 (36%) were first taken to a non-PCI hospital and later transferred. In a multivariable model, increase in differential driving time and cardiac arrest were associated with a lesser likelihood of being taken directly to a PCI center, whereas a history of PCI was associated with a higher likelihood of being taken directly to a PCI center. Patients sent directly to a PCI center were more likely to have first medical contact-to-PCI times within guideline recommendations CONCLUSIONS: We found that patients who were sent directly to a PCI center had significantly shorter time to reperfusion. |
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Authors:
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Emil L Fosbol; Christopher B Granger; James G Jollis; Lisa Monk; Li Lin; Barbara L Lytle; Ying Xian; J Lee Garvey; Greg Mears; Claire C Corbett; Eric D Peterson; Seth W Glickman |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-12-30 |
Journal Detail:
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Title: Circulation Volume: - ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2012 Dec |
Date Detail:
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Created Date: 2012-12-31 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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1 Duke Clinical Research Institute, Duke University Medical Center, Durham, NC; |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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