Abstract 147: ECG to Decision Time - Small Delays Deciding to Transfer a STEMI Patient Adds Much Larger Delays to Reperfusion Time

Abstract

Background: Non-PCI capable facilities are faced with a time critical challenge to transfer a STEMI patient to a PCI capable hospital for Primary PCI within 120 minutes of first medical contact. Once a 12-Lead ECG is obtained and printed, a period of time elapses before STEMI is recognized, and a decision is made to transfer the patient for Primary PCI. It seems logical that the ECG-to-Decision time should not impact the subsequent Decision-to-PCI time. We evaluated the impact of the time spent from ECG-to-Decision time on the subsequent Decision-to-PCI time. Methods: Data was combined, and retrospectively analyzed on 157 consecutive STEMI cases first identified at 32 non-PCI capable facilities, and transferred to one of two different PCI capable hospitals located in either Duluth, Minnesota, or Fargo, North Dakota. There were 124 cases from September 2013 through February 2015 at one hospital, and 33 cases from May 2013 through February 2015 at the other. Decision time was defined by the call time for inter-facility transport for Primary PCI, or the call time to the PCI capable hospital to request activation of the Cath Lab. Findings: 30% of patients had an ECG-to-Decision time of less than 5 minutes, with mean & median Decision-to-PCI times of 93 min. & 86 min. (range 38-231; SD = 34.8). Another 30% of patients had an ECG to Decision time between 5 to 9 minutes, with mean & median Decision-to-PCI times of 102 min. & 103 min. (range 46 - 158; SD = 23.3). 40% of patients had an ECG-to-Decision time of 10 minutes or greater, with mean & median Decision-to-PCI time of 131 & 124 minutes (range 58 - 239; SD = 47.9). For a 5-9 minute delay in ECG-to-Decision time, an additional 17 minute delay was added to the median Decision-to-PCI time. If the ECG-to-Decision time was delayed 10 minutes or more, an additional 38 minute delay was added to the median Decision-to-PCI time. Conclusion: We observed an escalating impact of delay on Decision-to-PCI time as the result of smaller increases in delay of ECG-to-Decision time. Our data suggests that a realistic goal for ECG-to-Decision time of under 5 minutes should be considered for non-PCI capable facilities, to avoid escalating delays in Primary PCI time for STEMI patients.