SUSTAINABILITY OF “PHYSICIAN-LESS” AUTOMATED PRE-HOSPITAL STEMI DIAGNOSIS AND CATHETERIZATION LABORATORY ACTIVATION TO ENSURE DOOR-TO-BALLOON TIMES: UPDATE AT 5 YEARS

Abstract

Primary percutaneous coronary intervention (pPCI) for ST elevation myocardial infarction (STEMI) is the revascularization method of choice provided that it can be achieved rapidly. Since 2010, we have adopted an automated system of pre-hospital CCL STEMI diagnosis at first medical contact and pre-hospital cardiac catheterization laboratory (CCL) activation without real-time physician oversight. This system was previously reported to significantly reduce door-to balloon (D2B) times at our center. Herein, we present our updated results at 5 years in order to report on the stability of the algorithm’s performance over time. Pre-hospital ECG’s were performed for all patients with a complaint of chest pain or shortness of breath. An electrographic diagnosis of STEMI (Zoll Medical Corporation) automatically resulted in CCL activation and direct transfer without prior physician interpretation of the ECG. Patient demographics, landmark time-points, treatments, and outcomes were abstracted for all consecutive pre-hospital CCL activations from February 2010 to January 2015. D2B was defined conventionally as the time from arrival at the hospital to first intracoronary device activation and contact-to-balloon (C2B) was defined as the time from first medical contact in the field to device activation. Over the study period, we identified 489 pre-hospital CCL activations for STEMI. In the first 253 activations analyzed, (full results will be presented at congress), 71% were male with a mean age of 65±14 years. 60% had high blood pressure, 58% dyslipidemia, 17% were known diabetics, and 21% had a history of known or suspected coronary disease. A total of 213 (84%) patients had a final diagnosis of STEMI. Of these, 207 (97%) underwent an attempt at PCI with a success rate of 97%. Median (IQR) D2B for this cohort was 46 minutes (35.75 - 56.0 min). The recommended D2B of <90 minutes was achieved in 99% of patients. Median (IQR) C2B was 75.5 minutes (67.0 - 87 min). The present series confirms that a high rate of target D2B times is achievable with a “physician-less” system of pre-hospital CCL activation. Furthermore, the present results demonstrate that such superior results appear sustained 5 years after protocol implementation.