Impact of Paramedic Transport with Prehospital 12-Lead Electrocardiography on Door-to-Balloon Times for Patients with ST-Segment Elevation Myocardial Infarction

OBJECTIVE: To determine the impact of prehospital 12-lead electrocardiograms (ECGs) on door-to-balloon times for ST-segment elevation myocardial infarction (STEMI) patients prior to the establishment of formally designated STEMI receiving centers. METHODS: This was a retrospective study comparing door-to-balloon times for acute STEMI patients transported by paramedics using prehospital 12-lead ECGs with those who arrived via self-transport at four Los Angeles area EDs that performed emergency percutaneous coronary intervention (PCI). Paramedics calling in from the field verbally notified receiving hospitals of a "STEMI patient." Activation of the hospital's PCI team was at the discretion of the receiving emergency physician. During the study period, there were no formal diversion criteria for STEMI patients. The main outcome measure was door-to-balloon time. RESULTS: During the study period, 234 patients met inclusion criteria, of whom 168 (72%) were male. The mean age was 62 years. There was no statistically significant difference in the age, gender, or ethnicity of the two groups. Median door-to-balloon times were 95 minutes and 108 minutes in the EMS and self-transport groups, respectively (p < 0.05; 95% confidence interval 3.5-16.4). CONCLUSION: Paramedic transport of STEMI patients with prehospital 12-lead ECG acquisition was associated with shorter door-to-balloon times than the times for patients who self-transported to PCI-capable EDs.