Integration of Pre-Hospital Electrocardiograms and ST-Elevation Myocardial Infarction Receiving Center (SRC) Networks Impact on Door-to-Balloon Times Across 10 Independent Regions

被引：144

作者：

Rokos, Ivan C. ^{[1
]}

French, William J. ^{[2
]}

Koenig, William J. ^{[3
]}

Stratton, Samuel J. ^{[4
]}

Nighswonger, Beverly ^{[4
]}

Strunk, Brian ^{[5
]}

Jewell, Jackie ^{[5
]}

Mahmud, Ehtisham ^{[6
]}

Dunford, James V. ^{[6
]}

Hokanson, Jon ^{[7
]}

Smith, Stephen W. ^{[8
]}

Baran, Kenneth W. ^{[9
]}

Swor, Robert ^{[10
]}

Berman, Aaron ^{[10
]}

Wilson, B. Hadley ^{[11
]}

Aluko, Akinyele O. ^{[12
]}

Gross, Brian W. ^{[13
]}

Rostykus, Paul S. ^{[14
]}

Salvucci, Angelo ^{[15
]}

Dev, Vishva ^{[16
]}

McNally, Bryan ^{[17
]}

Manoukian, Steven V. ^{[18
]}

King, Spencer B., III ^{[19
]}

机构：

[1] Univ Calif Los Angeles, UCLA Olive View Med Ctr, Dept Emergency Med, Geffen Sch Med, Sylmar, CA 91342 USA

[2] Harbor UCLA Med Ctr, Torrance, CA 90509 USA

[3] Los Angeles Cty EMS Agcy, Los Angeles, CA USA

[4] Orange Cty Hlth Care Agcy, Santa Ana, CA USA

[5] Marin Gen Hosp, Greenbrae, CA USA

[6] Univ Calif San Diego, San Diego, CA 92103 USA

[7] Abbott NW Hosp, Minneapolis, MN 55407 USA

[8] Univ Minnesota, Hennepin Cty Med Ctr, Minneapolis, MN 55415 USA

[9] United Hosp, St Paul, MN USA

[10] Beaumont Hosp, Royal Oak, MI USA

[11] Carolinas Med Ctr, Charlotte, NC 28203 USA

[12] Presbyterian Hosp, Charlotte, NC USA

[13] Heart Clin So Oregon, Medford, OR USA

[14] Jackson Cty EMS Agcy, Ashland, OR USA

[15] Ventura Cty EMS Agcy, Ventura, CA USA

[16] Los Robles Med Ctr, Thousand Oaks, CA USA

[17] Emory Univ, Sch Med, Atlanta, GA USA

[18] Sarah Cannon Res Inst, Nashville, TN USA

[19] St Josephs Hosp, Atlanta, GA USA

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2009年 / 2卷 / 04期

关键词：

D2B Alliance; door-to-balloon time; Mission: Lifeline; pre-hospital electrocardiogram; primary percutaneous coronary intervention; STEMI receiving center networks; ST-elevation myocardial infarction; AMERICAN-HEART-ASSOCIATION; PERCUTANEOUS CORONARY INTERVENTION; OUTCOMES RESEARCH; REPERFUSION; CARE; SYSTEMS; QUALITY; IMPLEMENTATION; TIMELINESS; GUIDELINES;

D O I：

10.1016/j.jcin.2008.11.013

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives The aim of this study was to evaluate the rate of timely reperfusion for ST-elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (PPCI) in regional STEMI Receiving Center (SRC) networks. Background The American College of Cardiology Door-to-Balloon (D2B) Alliance target is a >75% rate of D2B <= 90 min. Independent initiatives nationwide have organized regional SRC networks that coordinate universal access to 9-1-1 with the pre-hospital electrocardiogram (PH-ECG) diagnosis of STEMI and immediate transport to a SRC (designated PPCI-capable hospital). Methods A pooled analysis of 10 independent, prospective, observational registries involving 72 hospitals was performed. Data were collected on all consecutive patients with a PH-ECG diagnosis of STEMI. The D2B and emergency medical services (EMS)-to-balloon (E2B) times were recorded. Results Paramedics transported 2,712 patients with a PH-ECG diagnosis of STEMI directly to the nearest SRC. A PPCI was performed in 2,053 patients (76%) with an 86% rate of D2B <= 90 min (95% confidence interval: 84.4% to 87.4%). Secondary analyses of this cohort demonstrated a 50% rate of D2B <= 60 min (n = 1,031), 25% rate of D2B <= 45 min (n = 517), and an 8% rate of D2B <= 30 min (n = 155). A tertiary analysis restricted to 762 of 2,053 (37%) cases demonstrated a 68% rate of E2B <= 90 min. Conclusions Ten independent regional SRC networks demonstrated a combined 86% rate of D2B <= 90 min, and each region individually surpassed the American College of Cardiology D2B Alliance benchmark. In areas with regional SRC networks, 9-1-1 provides entire communities with timely access to quality STEMI care. (J Am Coll Cardiol Intv 2009;2:339-46) (C) 2009 by the American College of Cardiology Foundation

引用

页码：339 / 346

页数：8

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