Document Detail

Impact of transport pathways on the time from symptom onset of ST-segment elevation myocardial infarction to door of coronary intervention facility.
MedLine Citation:
PMID:  24397992     Owner:  NLM     Status:  Publisher    
BACKGROUND: Reducing total ischemic time is important in achieving better outcome in ST-segment elevation myocardial infarction (STEMI). Although the onset-to-door (OTD) time accounts for a large portion of the total ischemic time, factors affecting prolongation of the OTD time are not established.
PURPOSE: The purpose of this study was to determine the impact of transport pathways on OTD time in patients with STEMI.
METHODS AND SUBJECTS: We retrospectively studied 416 STEMI patients who were divided into 4 groups according to their transport pathways; Group 1 (n=41): self-transportation to percutaneous coronary intervention (PCI) facility; Group 2 (n=215): emergency medical service (EMS) transportation to PCI facility; Group 3 (n=103): self-transportation to non-PCI facility; and Group 4 (n=57): EMS transportation to non-PCI facility. OTD time was compared among the 4 groups.
ESSENTIAL RESULTS: Median OTD time for all groups combined was 113 (63-228.8)min [Group 1, 145 (70-256.5); Group 2, 71 (49-108); Group 3, 260 (142-433); and Group 4, 184 (130-256)min]. OTD time for EMS users (Groups 2 and 4) was 138min shorter than non-EMS users (Groups 1 and 3). Inter-hospital transportation (Groups 3 and 4) prolonged OTD by a median of 132min compared with direct transportation to PCI facility (Groups 1 and 2). Older age, history of myocardial infarction, prior PCI, shock at onset, high Killip classification, and high GRACE Risk Score were significantly more frequent in EMS users.
PRINCIPAL CONCLUSIONS: Self-transportation without EMS and inter-hospital transportation were significant factors causing prolongation of the OTD time. Approximately 35% of STEMI patients did not use EMS and 21% of patients were transported to non-PCI facilities even though they called EMS. Awareness in the community as well as among medical professionals to reduce total ischemic time of STEMI is necessary; this involves educating the general public and EMS crews.
Toshiharu Fujii; Naoki Masuda; Toshihiko Suzuki; Sho Trii; Tsutomu Murakami; Masataka Nakano; Gaku Nakazawa; Norihiko Shinozaki; Takashi Matsukage; Nobuhiko Ogata; Fuminobu Yoshimachi; Yuji Ikari
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-1-4
Journal Detail:
Title:  Journal of cardiology     Volume:  -     ISSN:  1876-4738     ISO Abbreviation:  J Cardiol     Publication Date:  2014 Jan 
Date Detail:
Created Date:  2014-1-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804703     Medline TA:  J Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013. Published by Elsevier Ltd.
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