Author + information
- Kulpreet Barn,
- Mian Muhammad Ali Akram,
- James Blankenship,
- Cinde Bower Stout,
- David Carey,
- Haiyan Sun,
- Kimberly Skelding,
- Thomas Scott and
- Peter Berger
Pre-hospital electrocardiograms (ECGs) are believed to reduce time to treatment in ST Segment Elevation Myocardial Infarction (STEMI) patients. Little is known of their impact in a rural setting, and on clinical outcomes. Within the Geisinger regional STEMI network, a rural regional STEMI system in central Pennsylvania, 19 non-percutaneous coronary intervention (PCI) hospitals up to 100 miles away transport patients to the Geisinger Medical Center (GMC), a PCI center.
We performed a retrospective analysis of 280 consecutive STEMI patients treated between 1/1/09–8/31/11. 205 patients were taken by the emergency medical system (EMS) to the nearest hospital (a non-PCI center), underwent an ECG revealing a STEMI, and were transported immediately to GMC for PCI, vs. 75 patients found to be suffering a STEMI on a pre-hospital ECG, bypassed the nearest hospital, and were transported directly to GMC for PCI.
Analysis of baseline characteristics revealed that the more recently treated, pre-hospital ECG cohort were older (65 vs. 60 years); more had suffered a prior myocardial infarction (28% vs. 15%), had a history of cardiac heart failure (11% vs. 4%) and prior PCI (23% vs. 13%), p<0.05 all comparisons; there were no significant differences in history of smoking, prior coronary artery bypass grafting, stroke, peripheral vascular disease, or diabetes. The medications the 2 groups received prior to the hospital and after arrival were similar, although clopidogrel and heparin were administered later in the pre-hospital ECG group. Median time from EMS contact to pre-hospital ECG in group 2 was 5 minutes; from pre-hospital ECG to the GMC emergency department was 34 minutes (25th, 75th percentiles 21, 45). The duration of symptoms to EMS was similar in both groups. Median minutes from 1st medical contact to cath lab arrival were 62 vs. 138 (p<0.001), from 1st emergency department to reperfusion (device activation) 39 vs 89 (p<0.001). Mortality in the 2 groups at one year was 4.1% vs. 8.3% (P value=0.34)
In a rural regional STEMI network, pre-hospital ECGs markedly shortened time from 1st medical contact to reperfusion, and were associated with a numerically lower mortality.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Pre-Hospital ECG and Transfer: Time Is Myocardium
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 1212-175
- 2013 American College of Cardiology Foundation