Patients with a scene departure to cath lab table time of ≤30 minutes were more likely to achieve percutaneous coronary intervention in ≤90 minutes (OR 11.1; 95% CI 3.4-36.0).
Observational (n=181)
Are specific prehospital time intervals associated with achieving first medical contact to percutaneous coronary intervention in ≤90 minutes in patients with acute STEMI?
Meeting specific prehospital timing benchmarks, particularly scene departure to catheterization laboratory table time ≤30 minutes, significantly increases the likelihood of achieving guideline-recommended first medical contact to PCI times in STEMI patients.
Odds Ratio: 11.1 (95% CI 3.4–36)
BACKGROUND: Among individuals experiencing an ST segment-elevation myocardial infarction, current guidelines recommend that the interval from first medical contact to percutaneous coronary intervention be ≤90 minutes. The objective of this study was to determine whether prehospital time intervals were associated with ST-elevation myocardial infarction system performance, defined as first medical contact to percutaneous coronary intervention. METHODS AND RESULTS: Study patients presented with an acute ST-elevation myocardial infarction diagnosed by prehospital ECG between May 2007 and March 2009. Prehospital time intervals were as follows: 9-1-1 call receipt to ambulance on scene ≤10 minutes, ambulance on scene to 12-lead ECG acquisition ≤8 minutes, on-scene time ≤15 minutes, prehospital ECG acquisition to ST-elevation myocardial infarction team notification ≤10 minutes, and scene departure to patient on cardiac catheterization laboratory table ≤30 minutes. Time intervals were derived and analyzed with descriptive statistics and logistic regression. There were 181 prehospital patients who received percutaneous coronary intervention, with 165 (91.1) having complete data. Logistic regression indicated that table time, response time, and on-scene time were the benchmark time intervals with the greatest influence on the probability of achieving percutaneous coronary intervention in ≤90 minutes. Individuals with a time from scene departure to arrival on cardiac catheterization laboratory table of ≤30 minutes were 11.1 times (3.4 to 36.0) more likely to achieve percutaneous coronary intervention in ≤90 minutes than those with extended table times. CONCLUSIONS: In this patient population, prehospital timing benchmarks were associated with system performance. Although meeting all 5 benchmarks may be an ideal goal, this model may be more useful for identifying areas for system improvement that will have the greatest clinical impact.
Studnek et al. (Tue,) conducted a observational in ST-elevation myocardial infarction (n=181). Scene departure to arrival on cardiac catheterization laboratory table ≤30 minutes vs. Extended table times (>30 minutes) was evaluated on Achieving percutaneous coronary intervention in ≤90 minutes (first medical contact to percutaneous coronary intervention) (OR 11.1, 95% CI 3.4-36.0). Patients with a scene departure to cath lab table time of ≤30 minutes were more likely to achieve percutaneous coronary intervention in ≤90 minutes (OR 11.1; 95% CI 3.4-36.0).