Integration of Pre-Hospital Electrocardiograms and ST-Elevation Myocardial Infarction Receiving Center (SRC) Networks: Impact on Door-to-Balloon Times Across 10 Independent Regions

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• 作者：Ivan C. Rokos ; MD^?/sup> ; ^{irokos@earthlink.net} ; William J. French ; MD^&dagger ; ; William J. Koenig ; MD^&Dagger ; ; Samuel J. Stratton ; MD ; MPH^§ ; ; Beverly Nighswonger ; RN^§ ; ; Brian Strunk ; MD^?/sup> ; Jackie Jewell ; RN^?/sup> ; Ehtisham Mahmud ; MD^¶ ; ; James V. Dunford ; MD^¶ ; ; Jon Hokanson ; MD^# ; Stephen W. Smith ; MD^?? ; Kenneth W. Baran ; MD^&dagger ; &dagger ; ; Robert Swor ; DO^&Dagger ; &Dagger ; ; Aaron Berman ; MD^&Dagger ; &Dagger ; ; B. Hadley Wilson ; MD^§ ; § ; ; Akinyele O. Aluko ; MD^¡Î¡Î ; Brian W. Gross ; MD^¶ ; ¶ ; ; Paul S. Rostykus ; MD ; MPH^## ; Angelo Salvucci ; MD^???/sup> ; Vishva Dev ; MD^&dagger ; &dagger ; &dagger ; ; Bryan McNally ; MD ; MPH^&Dagger ; &Dagger ; &Dagger ; ; Steven V. Manoukian ; MD^§ ; § ; § ; ; Spencer B. King III ; MD^{¡Î¡Î?/sup>}
• 关键词：D2B Alliance ; door-to-balloon time ; Mission ; Lifeline ; pre-hospital electrocardiogram ; primary percutaneous coronary intervention ; STEMI receiving center networks ; ST-elevation myocardial infarction
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2009
• 出版时间：April 2009
• 年：2009
• 卷：2
• 期：4
• 页码：339-346
• 全文大小：965 K

文摘

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Objectives

The aim of this study was to evaluate the rate of timely reperfusion for ST-elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (PPCI) in regional STEMI Receiving Center (SRC) networks.

Background

The American College of Cardiology Door-to-Balloon (D2B) Alliance target is a >75 % rate of D2B ?0 min. Independent initiatives nationwide have organized regional SRC networks that coordinate universal access to 9-1-1 with the pre-hospital electrocardiogram (PH-ECG) diagnosis of STEMI and immediate transport to a SRC (designated PPCI-capable hospital).

Methods

A pooled analysis of 10 independent, prospective, observational registries involving 72 hospitals was performed. Data were collected on all consecutive patients with a PH-ECG diagnosis of STEMI. The D2B and emergency medical services (EMS)-to-balloon (E2B) times were recorded.

Results

Paramedics transported 2,712 patients with a PH-ECG diagnosis of STEMI directly to the nearest SRC. A PPCI was performed in 2,053 patients (76 % ) with an 86 % rate of D2B ?0 min (95 % confidence interval: 84.4 % to 87.4 % ). Secondary analyses of this cohort demonstrated a 50 % rate of D2B ?0 min (n = 1,031), 25 % rate of D2B ?5 min (n = 517), and an 8 % rate of D2B ?0 min (n = 155). A tertiary analysis restricted to 762 of 2,053 (37 % ) cases demonstrated a 68 % rate of E2B ?0 min.

Conclusions

Ten independent regional SRC networks demonstrated a combined 86 % rate of D2B ?0 min, and each region individually surpassed the American College of Cardiology D2B Alliance benchmark. In areas with regional SRC networks, 9-1-1 provides entire communities with timely access to quality STEMI care.