Key result
A prehospital STEMI bypass protocol achieved a faster mean door-to-balloon time compared to self-presentations (77 min vs. 113 min), with no associated mortality or major adverse cardiac events.
Why the study?
Does a prehospital STEMI bypass protocol improve door-to-balloon times in patients with acute coronary syndrome?
Cohort (n=118)
Does a prehospital STEMI bypass protocol improve door-to-balloon times in patients with acute coronary syndrome?
Implementation of a prehospital STEMI bypass protocol in the UAE successfully achieved guideline-recommended door-to-balloon times of <90 minutes in over 80% of patients.
Answers are grounded in this paper and cite their sources.
Supports prehospital STEMI bypass for faster reperfusion; leaves open need for randomized outcome confirmation.
OBJECTIVE: The aim was to evaluate the translation of an ST-segment elevation myocardial infarction (STEMI) bypass protocol to the outcomes of patients with acute coronary syndrome in the Emirate of Ras al-Khaimah in the United Arab Emirates (UAE). METHODS: A prospective cohort study was conducted, which included all patients who had a prehospital 12-lead electrocardiogram (ECG) performed by ambulance crews. Analysis of those who were identified as having STEMI and who subsequently underwent percutaneous coronary intervention (PCI) was performed. RESULTS: A total of 152 patients had a 12-lead ECG performed during the pilot study period (February 24, 2016-August 31, 2016) with 118 included for analysis. Mean patient age was 52 years. There were 87 male (74%) and 31 female (26%) patients. Twenty-nine patients suffered a STEMI, and data were available for 11 who underwent PCI. There was no mortality, and no major adverse cardiac events were reported. The median door-to-balloon (D2B) time was 73 min (range 48-124), and 81% of patients had a D2B time < 90 min. Discharge data were available for six patients: All were discharged home with no impediments to rehabilitation. CONCLUSION: This pilot study has demonstrated agreement with the existing literature surrounding prehospital ECG and PCI activation in an unstudied STEMI population and in a novel clinical setting. It has demonstrated a D2B time of < 90 min in over 80% of STEMI patients, and a faster mean D2B time than self-presentations (mean 77 min vs. 113 min), with no associated mortality or major adverse cardiac events.
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Batt et al. (2018) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=118). Prehospital STEMI bypass protocol vs. Self-presentations was evaluated on Mean door-to-balloon (D2B) time. A prehospital STEMI bypass protocol achieved a faster mean door-to-balloon time compared to self-presentations (77 min vs. 113 min), with no associated mortality or major adverse cardiac events.
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