Prehospital activation of the cardiac catheterisation laboratory in ST-segment elevation myocardial infarction (STEMI) for primary percutaneous coronary intervention (PCI)

Background Prehospital activation of the cardiac catheter laboratory is associated with significant improvements in ST-segment elevation myocardial infarction (STEMI) performance measures. However, there is equivocal data, particularly within Australia regarding its influence on mortality. We assessed the association of prehospital activation on performance measures and mortality in STEMI patients treated with primary percutaneous coronary intervention (PCI) from the Queensland Cardiac Outcomes Registry (QCOR). Methods Consecutive ambulance transported STEMI patients treated with primary PCI were analysed from 1 st January 2017 to 31 st December 2020 from the QCOR. The total and direct effects of prehospital activation on the primary outcomes (30-day and 1-year cardiovascular mortality) were estimated using logistic regression analyses. Secondary outcomes were STEMI performance measures. Results Among 2498 patients (mean age: 62.2 ± 12.4 years; 79.2% male), 73% underwent prehospital activation. Median door-to-balloon (DTB) time (34mins [26-46] vs 86 mins [68-113]; p<0.001), first-electrocardiograph-to-balloon (ECGTB) time (83.5 mins [72-98] vs 109 mins [81-139]; p<0.001), and proportion of patients meeting STEMI targets (DTB<60mins 90% vs 16%; p<0.001), ECGTB<90mins (62% vs 33%; p<0.001) were significantly improved with prehospital activation. Prehospital activation was associated with significantly lower 30-day (1.6% vs 6.6%; p<0.001) and 1-year cardiovascular mortality (2.9% vs 9.5%; p<0.001). After adjustment, no prehospital activation was strongly associated with increased 30-day (OR: 3.6; 95%CI: 2.2-6.0, p<0.001) and 1-year cardiovascular mortality (OR: 3.0 (95%CI:2.0-4.6; p<0.001). Conclusions Prehospital activation of cardiac catheterisation laboratory for primary PCI was associated with significantly shorter time to reperfusion, achievement of STEMI performance measures and lower 30-day and 1-year cardiovascular mortality. Clinical Perspective In patients who suffer STEMI, prehospital activation of the cardiac catheter laboratory and initiation of medical therapy is associated with shorter time to reperfusion, greater achievement of performance measures and lower cardiovascular mortality This study adds to the existing literature and demonstrates that a standardised prehospital activation strategy can be implemented on a large scale Widespread implementation of standardised prehospital activation strategies may offer opportunity to expedite STEMI care and improve outcomes