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Few with ST-segment elevation myocardial infarction are diagnosed within 10 minutes from first medical contact, and women have longer delay times than men.

ABSTRACT: Background:Previous reports have questioned the feasibility and gender equality of obtaining a prehospital ECG within 10 minutes of ambulance arrival for patients with ST-segment elevation myocardial infarction (STEMI). The main objective of this study was to investigate the proportion of STEMI patients with a prehospital ECG within 10 minutes of ambulance arrival. The secondary objective was to study the gender differences in delay times in prehospital STEMI care. Methods:This study was a retrospective study based on 539 patients with STEMI at the investigating hospital. Ambulance and medical charts, as well as the national quality registry "SWEDEHEART", were reviewed for each patient for demographics and time information. Results:A prehospital ECG was obtained within 10 minutes of ambulance arrival for 99 (29%) of the men and 19 (14%) of the women, p = 0.001. Women had a 2 minutes longer delay between ambulance arrival and prehospital ECG (95% CI 0-4 min, p = 0.018) than men. Women also had a significantly longer patient delay. None of the other time intervals differed among men and women. Conclusions:Only for a minority of patients is a prehospital ECG taken within the recommended ten minutes from ambulance arrival. Women have longer patient delay times, as well as delay times to the acquisition of a prehospital ECG than men. Improvements of prehospital ECG acquisition and adjustments of the guidelines are warranted.

SUBMITTER: Muhrbeck J

PROVIDER: S-EPMC6948248 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Few with ST-segment elevation myocardial infarction are diagnosed within 10 minutes from first medical contact, and women have longer delay times than men.

Muhrbeck Josephine J Maliniak Eli E Eurenius Lars L Hofman-Bang Claes C Persson Jonas J

International journal of cardiology. Heart & vasculature 20200102

<h4>Background</h4>Previous reports have questioned the feasibility and gender equality of obtaining a prehospital ECG within 10 minutes of ambulance arrival for patients with ST-segment elevation myocardial infarction (STEMI). The main objective of this study was to investigate the proportion of STEMI patients with a prehospital ECG within 10 minutes of ambulance arrival. The secondary objective was to study the gender differences in delay times in prehospital STEMI care.<h4>Methods</h4>This st ...[more]

PMID: 31921973

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Project description:The Mission: Lifeline STEMI Systems Accelerator program, implemented in 16 US metropolitan regions, resulted in more patients receiving timely reperfusion. We assessed whether implementing key care processes was associated with system performance improvement. Hospitals (n=167 with 23 498 ST-segment-elevation myocardial infarction patients) were surveyed before (March 2012) and after (July 2014) program intervention. Data were merged with patient-level clinical data over the same period. For reperfusion, hospitals were grouped by whether a specific process of care was implemented, preexisting, or never implemented. Uptake of 4 key care processes increased after intervention: prehospital catheterization laboratory activation (62%-91%; P<0.001), single call transfer protocol from an outside facility (45%-70%; P<0.001), and emergency department bypass for emergency medical services direct presenters (48%-59%; P=0.002) and transfers (56%-79%; P=0.001). There were significant differences in median first medical contact-to-device times among groups implementing prehospital activation (88 minutes implementers versus 89 minutes preexisting versus 98 minutes nonimplementers; P<0.001 for comparisons). Similarly, patients treated at hospitals implementing single call transfer protocols had shorter median first medical contact-to-device times (112 versus 128 versus 152 minutes; P<0.001). Emergency department bypass was also associated with shorter median first medical contact-to-device times for emergency medical services direct presenters (84 versus 88 versus 94 minutes; P<0.001) and transfers (123 versus 127 versus 167 minutes; P<0.001). The Accelerator program increased uptake of key care processes, which were associated with improved system performance. These findings support efforts to implement regional ST-segment-elevation myocardial infarction networks focused on prehospital catheterization laboratory activation, single call transfer protocols, and emergency department bypass.

Project description:Background:The aim of the study was to evaluate the occurrence, duration and impact of time delays to primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction (STEMI). Methods:A total of 357 consecutive STEMI patients enrolled in the prospective Special Program University Medicine ACS (SPUM-ACS) cohort were included. In order to identify the causes behind a possible treatment delay, we constructed four different time points which included: 1) symptom onset to hospital arrival, 2) hospital arrival to arrival in the catheterization laboratory, 3) hospital arrival to first balloon inflation, and 4) time from arrival in the catheterization laboratory to first balloon inflation in addition to total ischemic time. Patients were stratified according to a delay > 3 h, > 30 min, > 90 min and > 1 h, respectively and major adverse events at 0, 30 and 365 days were analyzed. Results:Resuscitated STEMI patients (23 patients) and STEMI patients presenting at weekends (101 patients) and to lesser extent at night hours (100 patients) experienced more time delays than stable patients and those presenting at office hours. Median door-to-balloon time averaged 93 min in resuscitated, but 65 min in stable patients. Median door-to-balloon time at weekends and public holidays was 89 min, but 68 min at office hours. Median time from hospital arrival to cathlab arrival at weekends and public holidays was 30 min, but 15 min during office hours. Corresponding times for resuscitated patients was 45 and 15 min in stable patients. Of note, resuscitated patients were late presenters as regards time from symptoms onset to hospital arrival with a median time of 180 min compared to 155 min in stable patients. Median total ischemic time was 225 min for all patients, 223 min at day hours, 239 at night hours, 244 min at weekends, 233 min at office days, 220 min in stable patients and 273 min in resuscitated patients. Patients with STEMI who arrived > 3 h after symptom onset had a higher rate of myocardial infarction (MI) at 1 year (1.6% vs. 9% in < 3 h; P = 0.008). Furthermore, STEMI patients who had a delay of > 1 h from cathlab arrival to first balloon inflation had a higher rate of in hospital reinfarction at 0 day (0.6% vs. 0% in < 1 h; P = 0.007), MI at 30 days (0.8% vs. 0% in < 1 h; P = 0.001) and MI at 1 year (1.4% vs. 1.1% in < 1 h; P = 0.012). Similarly, in these patients, cardiac deaths at 0 day (0.8% vs. 0.6% in < 1 h; P = 0.035) and at 30 days (0.8% vs. 0.6% in < 1 h; P = 0.035) were higher as were major adverse cardiovascular events (MACCE) at 0 day (1.4% vs. 0.8% in < 1 h; P = 0.004). Conclusion:Resuscitated STEMI patients and those presenting at weekends and to lesser extent at night hours experienced more time delays and longer ischemic time than stable patients and those presenting at office hours. In STEMI patients, any delay in treatment increased their risk of MACCE. Efforts should focus on improving patient's awareness along with minimizing in-hospital transfer to the catheterization laboratory especially at weekends and in resuscitated patients.

Dataset Information

Few with ST-segment elevation myocardial infarction are diagnosed within 10 minutes from first medical contact, and women have longer delay times than men.

Publications

Few with ST-segment elevation myocardial infarction are diagnosed within 10 minutes from first medical contact, and women have longer delay times than men.

Similar Datasets

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