Integration of Pre-Hospital Electrocardiograms and ST-Elevation Myocardial Infarction Receiving Center (SRC) Networks. Impact on Door-to-Balloon Times Across 10 Independent Regions

Ivan C. Rokos, William J. French, William J. Koenig, Samuel J. Stratton, Beverly Nighswonger, Brian Strunk, Jackie Jewell, Ehtisham Mahmud, James V. Dunford, Jon Hokanson, Stephen W. Smith, Kenneth W. Baran, Robert Swor, Aaron Berman, B. Hadley Wilson, Akinyele O. Aluko, Brian W. Gross, Paul S. Rostykus, Angelo Salvucci, Vishva DevBryan McNally, Steven V. Manoukian, Spencer B. King

Research output: Contribution to journalArticlepeer-review

132 Scopus citations

Abstract

Objectives: The aim of this study was to evaluate the rate of timely reperfusion for ST-elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (PPCI) in regional STEMI Receiving Center (SRC) networks. Background: The American College of Cardiology Door-to-Balloon (D2B) Alliance target is a >75% rate of D2B ≤90 min. Independent initiatives nationwide have organized regional SRC networks that coordinate universal access to 9-1-1 with the pre-hospital electrocardiogram (PH-ECG) diagnosis of STEMI and immediate transport to a SRC (designated PPCI-capable hospital). Methods: A pooled analysis of 10 independent, prospective, observational registries involving 72 hospitals was performed. Data were collected on all consecutive patients with a PH-ECG diagnosis of STEMI. The D2B and emergency medical services (EMS)-to-balloon (E2B) times were recorded. Results: Paramedics transported 2,712 patients with a PH-ECG diagnosis of STEMI directly to the nearest SRC. A PPCI was performed in 2,053 patients (76%) with an 86% rate of D2B ≤90 min (95% confidence interval: 84.4% to 87.4%). Secondary analyses of this cohort demonstrated a 50% rate of D2B ≤60 min (n = 1,031), 25% rate of D2B ≤45 min (n = 517), and an 8% rate of D2B ≤30 min (n = 155). A tertiary analysis restricted to 762 of 2,053 (37%) cases demonstrated a 68% rate of E2B ≤90 min. Conclusions: Ten independent regional SRC networks demonstrated a combined 86% rate of D2B ≤90 min, and each region individually surpassed the American College of Cardiology D2B Alliance benchmark. In areas with regional SRC networks, 9-1-1 provides entire communities with timely access to quality STEMI care.

Original languageEnglish (US)
Pages (from-to)339-346
Number of pages8
JournalJACC: Cardiovascular Interventions
Volume2
Issue number4
DOIs
StatePublished - Apr 2009

Keywords

  • D2B Alliance
  • Mission: Lifeline
  • ST-elevation myocardial infarction
  • STEMI receiving center networks
  • door-to-balloon time
  • pre-hospital electrocardiogram
  • primary percutaneous coronary intervention

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