First Medical Contact to Balloon Time – The Impact of Field 12 Lead ECG

Abstract

Background: A door to balloon time (D2BT) of less than 90 min is a popular metric to measure efficiency of STEMI treatment with PCI. With the advent of pre-hospital thrombolysis, first medical contact to balloon, or needle, time (FMC2BT) is gaining popularity as the optimal metric in assessing systems of care in STEMI, with a FMC2BT of less than 90 min advocated. Aims: To investigate the effect of field 12 lead ECG to triage STEMI on FMC2BT. Methods and results: We performed a prospective interventional study involving 175 patients undergoing primary PCI who presented to a single health care network in 2011. The D2BT and FMC2BT of all patients (n = 97) who underwent PPCI following field ECG was compared to a contemporary group of 78 patients undergoing PPCI but not receiving field 12 lead ECG triage. The median D2BT of the pre-hospital triage group was 54 min compared to 115 min in the comparator group, P < 0.001.The median FMC2BT in the pre-hospital triage group was 106 min compared to 140 min in the group not receiving pre-hospital ECG (P < 0.001). The proportion of patients who achieved a FMC2BT of ≤90 min was 21.6% in patients receiving pre-hospital triage and 11.5% in the comparator group (P = 0.11). Conclusions: A FMC2BT of less than 90 min is difficult to achieve despite best practice pre-hospital 12 lead ECG triage and rapid hospital based reperfusion.