Abstract 11829: Improvement in Care and Outcomes for Ambulance-Transported ST-Elevation Myocardial Infarction Patients With and Without Out-of-Hospital Cardiac Arrest: A Mission: Lifeline STEMI ACCELERATOR Study

Abstract

Introduction: ST-elevation myocardial infarction (STEMI) patients with out-of-hospital cardiac arrest (OHCA) may not only benefit from timely intervention (PCI) but also from temperature management and other critical care that often is offered at a PCI-center. Relative to non-OHCA STEMI patients, those with OHCA have previously been less likely to bypass the nearest hospital to reach a cardiac center. Methods: We reported time trends in emergency medical service (EMS) transport pattern and care of STEMI patients with and without OHCA included from ACTION®-GWTG™ hospitals (484 hospitals and 1253 EMS agencies in 16 US regions) with participation in the STEMI ACCELERATOR Mission: Lifeline (MLL) initiative between July 1 st 2012 (2012Q3) and March 31 st 2014 (2014Q1). Time trends by quarter were assessed using logistic regression with Generalized Estimating Equations to account for hospital clustering. Results: Of 13,189 EMS-transported patients, 88.7% (N=11,703) were direct presenters and 10.5% (N=1,227) of these had OHCA. Among 1,486 transfer-in patients, 21.7% (N=322) had OHCA. The proportion with OHCA taken directly to a PCI-center increased from 74.7% to 83.6% between 2012Q3-2014Q1 (OR per quarter= 1.07; 95% CI=1.02-1.14), compared to an increase of 89.0% to 91.0% for non-OHCA patients (OR=1.03; 95% CI=0.99-1.07; interaction p=0.23). Proportions examined with a prehospital ECG increased in both direct presenter groups (53.9% to 61.9% for OHCA; and 73.9% to 81.9% for non-OHCA; interaction p=0.12). Of 997 direct OHCA patients treated with primary PCI, a first medical contact(FMC-)-to-device time ≤90 minutes was met for 34.5% in 2012Q3 vs. 41.8% in 2014Q1 (51.6% and 56.1% for 9352 non-OHCA direct presenters treated with primary PCI; interaction p=0.72). In-hospital mortality for primary PCI-treated patients was 29.8% for direct OHCA presenters vs. 35.9% for transfer-in OHCA patients (OR=0.76; 95% CI=0.56-1.02), compared to 4.1% vs. 5.3% for non-OHCA direct vs. transfer-in patients (OR=0.86; 95% CI=0.64-1.16; interaction p=0.49). Conclusion: Increases in proportions with prehospital ECG, with direct transport to a PCI-center, and meeting FMC-to-device guideline-recommended goals were seen for STEMI patients with and without OHCA.