Pre-hospital 12 Lead ECG to Triage ST Elevation Myocardial Infarction and Long Term Improvements in Door to Balloon Times: The First 1000 Patients From the MonAMI Project

Abstract

Pre-hospital ECG is one strategy to improve door to balloon times (D2BT), however its long term effectiveness to sustain reductions in D2BT has not been evaluated. From 2007 to 2011 we conducted a prospective interventional study involving 1000 patients undergoing primary PCI (PPCI) at a single tertiary referral institution to determine the long term impact of pre-hospital 12 lead ECG on D2BT. The median D2BT of patients (n=414) who underwent PPCI following field 12-lead ECG was 54 min [IQR: 37-71 min] compared to the median time of a contemporary group (n=586) undergoing PPCI during the same period but not presenting via field triage of 100 min [74-134] (p<0.001). The proportion of patients who achieved a D2BT of ≤90 min in the pre-hospital ECG group was greater than that in the contemporary group (90% vs 42%, p<0.001). A comparison of the first 250 patients compared to subsequent 250 patient blocks showed no change in D2BT. Introduction of pre-hospital ECG in the triage of STEMI resulted in a sustained reduction in D2BT.