Abstract
Introduction: Early recognition and rapid revascularization is associated with improved outcomes in patients with STEMI. Increasingly, prehospital providers acquire ECGs, transport patients to PCI-ready hospitals, and activate interventional cardiology teams in advance of arrival (“door time”). Therefore, the time from first medical contact (FMC) with either EMS providers or the emergency department may be an important metric for overall system performance in the care of patients with STEMI. Hypothesis: A prehospital ECG transmission program will be associated with a decreased median FMC to revascularization device deployment time. Methods: A retrospective cohort study of Action Registry-GWTG data in Chicago was performed. The Chicago Fire Department implemented a 12-lead ECG program in 2012. Patients with confirmed STEMI from January through December 2013 were included. A baseline median FMC to device time was determined for the third quarter of 2012, at the start of the ECG program. Descriptive statistics were used for analysis. Results: Over the study period, 322 patients experiencing STEMI were treated in 9 hospitals. Patients were predominantly male (66%), and 50% arrived by ambulance. The average median FMC to device time during the study was 83 minutes, which decreased from an initial baseline of 104 minutes. The median time from FMC to door and from catheterization laboratory arrival to device remained constant over the study period (24 minutes and 22 minutes respectively), but the median time from door to catheterization laboratory decreased from 42 minutes to 33 minutes. Conclusions: Implementation of a prehospital ECG transmission program was associated with a decreased median FMC to device time in a large city, with FMC to device times consistently less than 90 minutes. The median door to device time for all patients regardless of arrival mode decreased too suggesting improved care processes for all patients with STEMI.
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