June 28, 2019Heart
Emergency medical service delays in ST-elevation myocardial infarction: a meta-analysis
Key result
The weighted mean FMC-to-door time for STEMI patients was 41 minutes, and a 10-minute increase in this delay was associated with a 10.6% reduction in patients treated within 90 minutes (p<0.001).
Why the study?
To evaluate emergency medical services delays and their impact on time to treatment and mortality in patients with STEMI.
Do emergency medical service delays impact the proportion of patients treated within 90 minutes and mortality in patients with STEMI?
Study Design
Type
Meta-Analysis (n=125,343)
Multicenter
Yes
Structured PICO
Do emergency medical service delays impact the proportion of patients treated within 90 minutes and mortality in patients with STEMI?
P
Population
125,343 patients with ST-elevation myocardial infarction (STEMI) pooled from 100 studies across 20 countries.
I
Intervention
Emergency medical services (EMS) delays (specifically first medical contact to hospital door time)
C
Comparator
Shorter EMS delays
O
Outcome
Time in minutes between first medical contact and arrival at hospital door (FMC-to-door time)surrogate
EMS delays account for half of total system delay in STEMI, and longer delays significantly reduce the proportion of patients treated within guideline-recommended timeframes.
Limitations
- Substantial heterogeneity was observed with each interval
- Substantial heterogeneity observed with each interval
Authors
Discussion
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Implication
EMS delays may limit timely STEMI reperfusion; leaves open whether targeted reductions improve mortality.
Cite This Study
Alrawashdeh et al. (2019) conducted a meta-analysis in ST-elevation myocardial infarction (STEMI) (n=125,343). Emergency medical services (EMS) delays was evaluated on Time in minutes between first medical contact and arrival at hospital door (FMC-to-door time) (95% CI 39 to 43). The weighted mean FMC-to-door time for STEMI patients was 41 minutes, and a 10-minute increase in this delay was associated with a 10.6% reduction in patients treated within 90 minutes (p<0.001).