| Nationwide Improvement of Door-to-Balloon Times in Patients With Acute ST-Segment Elevation Myocardial Infarction Requiring Primary Percutaneous Coronary Intervention With Out-of-Hospital 12-Lead ECG Recording and Transmission. | |
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MedLine Citation:
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PMID: 23021348 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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STUDY OBJECTIVE: Reducing door-to-balloon times for acute ST-segment elevation myocardial infarction (STEMI) patients has been shown to improve long-term survival. We aim to reduce door-to-balloon time for STEMI patients requiring primary percutaneous coronary intervention by adoption of out-of-hospital 12-lead ECG transmission by Singapore's national ambulance service. METHODS: This was a nationwide, before-after study of STEMI patients who presented to the emergency departments (ED) and required percutaneous coronary intervention. In the before phase, chest pain patients received 12-lead ECGs in the ED. In the after phase, 12-lead ECGs were performed by ambulance crews and transmitted from the field to the ED. Patients whose ECG showed greater than or equal to 2 mm ST-segment elevation in anterior or greater than or equal to 1 mm ST-segment elevation in inferior leads for 2 or more contiguous leads and symptom onset of less than 12 hours' duration were eligible for percutaneous coronary intervention activation before arrival. RESULTS: ECGs (2,653) were transmitted by the ambulance service; 180 (7%) were suspected STEMI. One hundred twenty-seven patients from the before and 156 from the after phase met inclusion criteria for analysis. Median door-to-balloon time was 75 minutes in the before and 51 minutes in the after phase (median difference=23 minutes; 95% confidence interval 18 to 27 minutes). Median door-to-balloon times were significantly reduced regardless of presentation hours. Overall, there was significant reduction in door-to-activation, door-to-ECG, and door-to-cardiovascular laboratory times. No significant difference was found pertaining to adverse events. CONCLUSION: This study describes a nationwide implementation of out-of-hospital ECG transmission resulting in reduced door-to-balloon times, regardless of presentation hours. Out-of-hospital ECG transmission should be adopted as best practice for management of chest pain. |
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Authors:
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Marcus Eng Hock Ong; Aaron Sung Lung Wong; Chong Meng Seet; Swee Guan Teo; Beng Leong Lim; Paul Jau Lueng Ong; Shieh Mei Lai; Sea Hing Ong; Francis Chun Yue Lee; Kim Poh Chan; Venkataraman Anantharaman; Terrance Siang Jin Chua; Pin Pin Pek; Huihua Li |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-9-26 |
Journal Detail:
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Title: Annals of emergency medicine Volume: - ISSN: 1097-6760 ISO Abbreviation: Ann Emerg Med Publication Date: 2012 Sep |
Date Detail:
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Created Date: 2012-10-1 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8002646 Medline TA: Ann Emerg Med Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2012. Published by Mosby, Inc. |
Affiliation:
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Department of Emergency Medicine, Singapore General Hospital, Singapore. Electronic address: marcus.ong.e.h@sgh.com.sg. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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