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Factors associated with door-in to door-out delays among ST-segment elevation myocardial infarction (STEMI) patients transferred for primary percutaneous coronary intervention: a population-based cohort study in Ontario, Canada
Compared to ST-segment elevation myocardial infarction (STEMI) patients who present at centres with catheterization facilities, those transferred for primary percutaneous coronary intervention (PCI) have substantially longer door-in to door-out (DIDO) times, where DIDO is defined as the time interva...
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| Published in: | BMC cardiovascular disorders 2018-10, Vol.18 (1), p.204-204, Article 204 |
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| creator | Shi, Oumin Khan, Anam M Rezai, Mohammad R Jackevicius, Cynthia A Cox, Jafna Atzema, Clare L Ko, Dennis T Stukel, Thérèse A Lambert, Laurie J Natarajan, Madhu K Zheng, Zhi-Jie Tu, Jack V |
| description | Compared to ST-segment elevation myocardial infarction (STEMI) patients who present at centres with catheterization facilities, those transferred for primary percutaneous coronary intervention (PCI) have substantially longer door-in to door-out (DIDO) times, where DIDO is defined as the time interval from arrival at a non-PCI hospital, to transfer to a PCI hospital. We aimed to identify potentially modifiable factors to improve DIDO times in Ontario, Canada and to assess the impact of DIDO times on 30-day mortality.
A population-based, retrospective cohort study of 966 STEMI patients transferred for primary PCI in Ontario in 2012 was conducted. Baseline factors were examined across timely DIDO status. Multivariate logistic regression was used to examine independent predictors of timely DIDO as well as the association between DIDO times and 30-day mortality.
The median DIDO time was 55 min, with 20.1% of patients achieving the recommended DIDO benchmark of ≤30 min. Age (OR
0.30, 95% CI: 0.16-0.56), symptom-to-first medical contact (FMC) time (OR
0.60, 95% CI: 0.39-0.90; OR
0.53, 95% CI:0.35-0.81) and emergency medical services transport with a pre-hospital electrocardiogram (ECG) (OR
2.63, 95% CI:1.59-4.35) were the strongest predictors of timely DIDO. Patients with timely ECG were more likely to have recommended DIDO times (33.0% vs 12.3%; P |
| doi_str_mv | 10.1186/s12872-018-0940-z |
| format | article |
| fullrecord | <record><control><sourceid>proquest_doaj_</sourceid><recordid>TN_cdi_doaj_primary_oai_doaj_org_article_e5eefbbd7479486c9b6903de50d6da77</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><doaj_id>oai_doaj_org_article_e5eefbbd7479486c9b6903de50d6da77</doaj_id><sourcerecordid>2135048686</sourcerecordid><originalsourceid>FETCH-LOGICAL-c423t-f89a6ed3e02346d61af87e1d74772dfaeecdd5a83076890949c618f9e74e1b983</originalsourceid><addsrcrecordid>eNpdksFuEzEQhlcIREvhAbggS1yKxIK93tjeHpBQ1UKkoh4aztbEnk0cbexge4Pa1-VFcJpQtZzWmv3ms2f0V9VbRj8xpsTnxBolm5oyVdOupfXds-qYtZLVTSPY80fno-pVSitKmVS0e1kdccoln3BxXP25BJNDTARSCsZBRkt-u7wkNoRYO09y2B_DmInFAW4Lug5-QW5mdcLFGn0mOOAWsguerG-DgWgdDMT5HqK5r57ezC5-TD-QTYEKn0iO4FOPMZbb-hDJJro1xFuywWjGDB7DmIgJMfhd1fmMcVsai-uMANmEzTjc31fPIRWFCcsQM0l5tDuaXPsM0YWP5Bw8WHhdvehhSPjm8D2pfl5ezM6_11fX36bnX69q0zY8173qQKDlSBveCisY9Eois7KVsrE9IBprJ6A4lUJ1ZeGdEUz1HcoW2bxT_KSa7r02wEofZtIBnL4vhLjQELMzA2qcIPbz-c7dtUqYbi46yi1OqBUWpCyuL3vXZpyv0ZoyfYThifTpH--WehG2WjS0qFgRnB4EMfwaMWW9dsngMOy3qxvWSNYJxUVB3_-HrsIYfVlVofiElgeqHcX2lIkhpYj9w2MY1bs46n0cdYmj3sVR35Wed4-neOj4lz_-F3VU4rc</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2135048686</pqid></control><display><type>article</type><title>Factors associated with door-in to door-out delays among ST-segment elevation myocardial infarction (STEMI) patients transferred for primary percutaneous coronary intervention: a population-based cohort study in Ontario, Canada</title><source>Open Access: PubMed Central</source><source>Publicly Available Content (ProQuest)</source><creator>Shi, Oumin ; Khan, Anam M ; Rezai, Mohammad R ; Jackevicius, Cynthia A ; Cox, Jafna ; Atzema, Clare L ; Ko, Dennis T ; Stukel, Thérèse A ; Lambert, Laurie J ; Natarajan, Madhu K ; Zheng, Zhi-Jie ; Tu, Jack V</creator><creatorcontrib>Shi, Oumin ; Khan, Anam M ; Rezai, Mohammad R ; Jackevicius, Cynthia A ; Cox, Jafna ; Atzema, Clare L ; Ko, Dennis T ; Stukel, Thérèse A ; Lambert, Laurie J ; Natarajan, Madhu K ; Zheng, Zhi-Jie ; Tu, Jack V</creatorcontrib><description>Compared to ST-segment elevation myocardial infarction (STEMI) patients who present at centres with catheterization facilities, those transferred for primary percutaneous coronary intervention (PCI) have substantially longer door-in to door-out (DIDO) times, where DIDO is defined as the time interval from arrival at a non-PCI hospital, to transfer to a PCI hospital. We aimed to identify potentially modifiable factors to improve DIDO times in Ontario, Canada and to assess the impact of DIDO times on 30-day mortality.
A population-based, retrospective cohort study of 966 STEMI patients transferred for primary PCI in Ontario in 2012 was conducted. Baseline factors were examined across timely DIDO status. Multivariate logistic regression was used to examine independent predictors of timely DIDO as well as the association between DIDO times and 30-day mortality.
The median DIDO time was 55 min, with 20.1% of patients achieving the recommended DIDO benchmark of ≤30 min. Age (OR
0.30, 95% CI: 0.16-0.56), symptom-to-first medical contact (FMC) time (OR
0.60, 95% CI: 0.39-0.90; OR
0.53, 95% CI:0.35-0.81) and emergency medical services transport with a pre-hospital electrocardiogram (ECG) (OR
2.63, 95% CI:1.59-4.35) were the strongest predictors of timely DIDO. Patients with timely ECG were more likely to have recommended DIDO times (33.0% vs 12.3%; P < 0.001). A significantly higher proportion of those who met the DIDO benchmark had timely FMC-to-balloon times (78.7% vs 27.4%; P < 0.001). Compared to patients with DIDO time ≤ 30 min, those with DIDO times > 90 min had significantly higher adjusted 30-day mortality rates (OR 2.82, 95% CI:1.10-7.19).
While benchmark DIDO times were still rarely achieved in the province, we identified several potentially modifiable factors in the STEMI system that might be targeted to improve DIDO times. Our findings that patients who received a pre-hospital ECG were still being transferred to non-PCI capable centres suggest strategies addressing this gap may improve patient outcomes.</description><identifier>ISSN: 1471-2261</identifier><identifier>EISSN: 1471-2261</identifier><identifier>DOI: 10.1186/s12872-018-0940-z</identifier><identifier>PMID: 30373536</identifier><language>eng</language><publisher>England: BioMed Central</publisher><subject>Adolescent ; Adult ; Age Factors ; Aged ; Ambulatory care ; Angioplasty ; Balloon treatment ; Benchmarking ; Catheterization ; Cohort analysis ; Databases, Factual ; Door-in to door-out (DIDO) ; EKG ; Electrocardiography ; Emergency Medical Services ; Emergency services ; Female ; Heart attacks ; Hospitals ; Humans ; Male ; Middle Aged ; Mortality ; Myocardial infarction ; Ontario ; Patient Transfer ; Patients ; Percutaneous Coronary Intervention - adverse effects ; Percutaneous Coronary Intervention - mortality ; Population ; Population studies ; Population-based studies ; Pre-hospital electrocardiogram (ECG) ; Primary percutaneous coronary intervention (PCI) ; Privacy ; Quality Improvement ; Quality Indicators, Health Care ; Retrospective Studies ; Risk Factors ; ST Elevation Myocardial Infarction - diagnostic imaging ; ST Elevation Myocardial Infarction - mortality ; ST Elevation Myocardial Infarction - surgery ; ST-segment elevation myocardial infarction (STEMI) ; Studies ; Time Factors ; Time-to-Treatment ; Treatment Outcome ; Young Adult</subject><ispartof>BMC cardiovascular disorders, 2018-10, Vol.18 (1), p.204-204, Article 204</ispartof><rights>Copyright © 2018. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s). 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c423t-f89a6ed3e02346d61af87e1d74772dfaeecdd5a83076890949c618f9e74e1b983</citedby><cites>FETCH-LOGICAL-c423t-f89a6ed3e02346d61af87e1d74772dfaeecdd5a83076890949c618f9e74e1b983</cites><orcidid>0000-0002-3028-6113</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6206901/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2135048686?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,25732,27903,27904,36991,36992,44569,53770,53772</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30373536$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shi, Oumin</creatorcontrib><creatorcontrib>Khan, Anam M</creatorcontrib><creatorcontrib>Rezai, Mohammad R</creatorcontrib><creatorcontrib>Jackevicius, Cynthia A</creatorcontrib><creatorcontrib>Cox, Jafna</creatorcontrib><creatorcontrib>Atzema, Clare L</creatorcontrib><creatorcontrib>Ko, Dennis T</creatorcontrib><creatorcontrib>Stukel, Thérèse A</creatorcontrib><creatorcontrib>Lambert, Laurie J</creatorcontrib><creatorcontrib>Natarajan, Madhu K</creatorcontrib><creatorcontrib>Zheng, Zhi-Jie</creatorcontrib><creatorcontrib>Tu, Jack V</creatorcontrib><title>Factors associated with door-in to door-out delays among ST-segment elevation myocardial infarction (STEMI) patients transferred for primary percutaneous coronary intervention: a population-based cohort study in Ontario, Canada</title><title>BMC cardiovascular disorders</title><addtitle>BMC Cardiovasc Disord</addtitle><description>Compared to ST-segment elevation myocardial infarction (STEMI) patients who present at centres with catheterization facilities, those transferred for primary percutaneous coronary intervention (PCI) have substantially longer door-in to door-out (DIDO) times, where DIDO is defined as the time interval from arrival at a non-PCI hospital, to transfer to a PCI hospital. We aimed to identify potentially modifiable factors to improve DIDO times in Ontario, Canada and to assess the impact of DIDO times on 30-day mortality.
A population-based, retrospective cohort study of 966 STEMI patients transferred for primary PCI in Ontario in 2012 was conducted. Baseline factors were examined across timely DIDO status. Multivariate logistic regression was used to examine independent predictors of timely DIDO as well as the association between DIDO times and 30-day mortality.
The median DIDO time was 55 min, with 20.1% of patients achieving the recommended DIDO benchmark of ≤30 min. Age (OR
0.30, 95% CI: 0.16-0.56), symptom-to-first medical contact (FMC) time (OR
0.60, 95% CI: 0.39-0.90; OR
0.53, 95% CI:0.35-0.81) and emergency medical services transport with a pre-hospital electrocardiogram (ECG) (OR
2.63, 95% CI:1.59-4.35) were the strongest predictors of timely DIDO. Patients with timely ECG were more likely to have recommended DIDO times (33.0% vs 12.3%; P < 0.001). A significantly higher proportion of those who met the DIDO benchmark had timely FMC-to-balloon times (78.7% vs 27.4%; P < 0.001). Compared to patients with DIDO time ≤ 30 min, those with DIDO times > 90 min had significantly higher adjusted 30-day mortality rates (OR 2.82, 95% CI:1.10-7.19).
While benchmark DIDO times were still rarely achieved in the province, we identified several potentially modifiable factors in the STEMI system that might be targeted to improve DIDO times. Our findings that patients who received a pre-hospital ECG were still being transferred to non-PCI capable centres suggest strategies addressing this gap may improve patient outcomes.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Ambulatory care</subject><subject>Angioplasty</subject><subject>Balloon treatment</subject><subject>Benchmarking</subject><subject>Catheterization</subject><subject>Cohort analysis</subject><subject>Databases, Factual</subject><subject>Door-in to door-out (DIDO)</subject><subject>EKG</subject><subject>Electrocardiography</subject><subject>Emergency Medical Services</subject><subject>Emergency services</subject><subject>Female</subject><subject>Heart attacks</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Myocardial infarction</subject><subject>Ontario</subject><subject>Patient Transfer</subject><subject>Patients</subject><subject>Percutaneous Coronary Intervention - adverse effects</subject><subject>Percutaneous Coronary Intervention - mortality</subject><subject>Population</subject><subject>Population studies</subject><subject>Population-based studies</subject><subject>Pre-hospital electrocardiogram (ECG)</subject><subject>Primary percutaneous coronary intervention (PCI)</subject><subject>Privacy</subject><subject>Quality Improvement</subject><subject>Quality Indicators, Health Care</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>ST Elevation Myocardial Infarction - diagnostic imaging</subject><subject>ST Elevation Myocardial Infarction - mortality</subject><subject>ST Elevation Myocardial Infarction - surgery</subject><subject>ST-segment elevation myocardial infarction (STEMI)</subject><subject>Studies</subject><subject>Time Factors</subject><subject>Time-to-Treatment</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>1471-2261</issn><issn>1471-2261</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNpdksFuEzEQhlcIREvhAbggS1yKxIK93tjeHpBQ1UKkoh4aztbEnk0cbexge4Pa1-VFcJpQtZzWmv3ms2f0V9VbRj8xpsTnxBolm5oyVdOupfXds-qYtZLVTSPY80fno-pVSitKmVS0e1kdccoln3BxXP25BJNDTARSCsZBRkt-u7wkNoRYO09y2B_DmInFAW4Lug5-QW5mdcLFGn0mOOAWsguerG-DgWgdDMT5HqK5r57ezC5-TD-QTYEKn0iO4FOPMZbb-hDJJro1xFuywWjGDB7DmIgJMfhd1fmMcVsai-uMANmEzTjc31fPIRWFCcsQM0l5tDuaXPsM0YWP5Bw8WHhdvehhSPjm8D2pfl5ezM6_11fX36bnX69q0zY8173qQKDlSBveCisY9Eois7KVsrE9IBprJ6A4lUJ1ZeGdEUz1HcoW2bxT_KSa7r02wEofZtIBnL4vhLjQELMzA2qcIPbz-c7dtUqYbi46yi1OqBUWpCyuL3vXZpyv0ZoyfYThifTpH--WehG2WjS0qFgRnB4EMfwaMWW9dsngMOy3qxvWSNYJxUVB3_-HrsIYfVlVofiElgeqHcX2lIkhpYj9w2MY1bs46n0cdYmj3sVR35Wed4-neOj4lz_-F3VU4rc</recordid><startdate>20181029</startdate><enddate>20181029</enddate><creator>Shi, Oumin</creator><creator>Khan, Anam M</creator><creator>Rezai, Mohammad R</creator><creator>Jackevicius, Cynthia A</creator><creator>Cox, Jafna</creator><creator>Atzema, Clare L</creator><creator>Ko, Dennis T</creator><creator>Stukel, Thérèse A</creator><creator>Lambert, Laurie J</creator><creator>Natarajan, Madhu K</creator><creator>Zheng, Zhi-Jie</creator><creator>Tu, Jack V</creator><general>BioMed Central</general><general>BMC</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-3028-6113</orcidid></search><sort><creationdate>20181029</creationdate><title>Factors associated with door-in to door-out delays among ST-segment elevation myocardial infarction (STEMI) patients transferred for primary percutaneous coronary intervention: a population-based cohort study in Ontario, Canada</title><author>Shi, Oumin ; Khan, Anam M ; Rezai, Mohammad R ; Jackevicius, Cynthia A ; Cox, Jafna ; Atzema, Clare L ; Ko, Dennis T ; Stukel, Thérèse A ; Lambert, Laurie J ; Natarajan, Madhu K ; Zheng, Zhi-Jie ; Tu, Jack V</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c423t-f89a6ed3e02346d61af87e1d74772dfaeecdd5a83076890949c618f9e74e1b983</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Ambulatory care</topic><topic>Angioplasty</topic><topic>Balloon treatment</topic><topic>Benchmarking</topic><topic>Catheterization</topic><topic>Cohort analysis</topic><topic>Databases, Factual</topic><topic>Door-in to door-out (DIDO)</topic><topic>EKG</topic><topic>Electrocardiography</topic><topic>Emergency Medical Services</topic><topic>Emergency services</topic><topic>Female</topic><topic>Heart attacks</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Myocardial infarction</topic><topic>Ontario</topic><topic>Patient Transfer</topic><topic>Patients</topic><topic>Percutaneous Coronary Intervention - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>BMC cardiovascular disorders</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shi, Oumin</au><au>Khan, Anam M</au><au>Rezai, Mohammad R</au><au>Jackevicius, Cynthia A</au><au>Cox, Jafna</au><au>Atzema, Clare L</au><au>Ko, Dennis T</au><au>Stukel, Thérèse A</au><au>Lambert, Laurie J</au><au>Natarajan, Madhu K</au><au>Zheng, Zhi-Jie</au><au>Tu, Jack V</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Factors associated with door-in to door-out delays among ST-segment elevation myocardial infarction (STEMI) patients transferred for primary percutaneous coronary intervention: a population-based cohort study in Ontario, Canada</atitle><jtitle>BMC cardiovascular disorders</jtitle><addtitle>BMC Cardiovasc Disord</addtitle><date>2018-10-29</date><risdate>2018</risdate><volume>18</volume><issue>1</issue><spage>204</spage><epage>204</epage><pages>204-204</pages><artnum>204</artnum><issn>1471-2261</issn><eissn>1471-2261</eissn><abstract>Compared to ST-segment elevation myocardial infarction (STEMI) patients who present at centres with catheterization facilities, those transferred for primary percutaneous coronary intervention (PCI) have substantially longer door-in to door-out (DIDO) times, where DIDO is defined as the time interval from arrival at a non-PCI hospital, to transfer to a PCI hospital. We aimed to identify potentially modifiable factors to improve DIDO times in Ontario, Canada and to assess the impact of DIDO times on 30-day mortality.
A population-based, retrospective cohort study of 966 STEMI patients transferred for primary PCI in Ontario in 2012 was conducted. Baseline factors were examined across timely DIDO status. Multivariate logistic regression was used to examine independent predictors of timely DIDO as well as the association between DIDO times and 30-day mortality.
The median DIDO time was 55 min, with 20.1% of patients achieving the recommended DIDO benchmark of ≤30 min. Age (OR
0.30, 95% CI: 0.16-0.56), symptom-to-first medical contact (FMC) time (OR
0.60, 95% CI: 0.39-0.90; OR
0.53, 95% CI:0.35-0.81) and emergency medical services transport with a pre-hospital electrocardiogram (ECG) (OR
2.63, 95% CI:1.59-4.35) were the strongest predictors of timely DIDO. Patients with timely ECG were more likely to have recommended DIDO times (33.0% vs 12.3%; P < 0.001). A significantly higher proportion of those who met the DIDO benchmark had timely FMC-to-balloon times (78.7% vs 27.4%; P < 0.001). Compared to patients with DIDO time ≤ 30 min, those with DIDO times > 90 min had significantly higher adjusted 30-day mortality rates (OR 2.82, 95% CI:1.10-7.19).
While benchmark DIDO times were still rarely achieved in the province, we identified several potentially modifiable factors in the STEMI system that might be targeted to improve DIDO times. Our findings that patients who received a pre-hospital ECG were still being transferred to non-PCI capable centres suggest strategies addressing this gap may improve patient outcomes.</abstract><cop>England</cop><pub>BioMed Central</pub><pmid>30373536</pmid><doi>10.1186/s12872-018-0940-z</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0002-3028-6113</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | BMC cardiovascular disorders, 2018-10, Vol.18 (1), p.204-204, Article 204 |
| issn | 1471-2261 1471-2261 |
| language | eng |
| recordid | cdi_doaj_primary_oai_doaj_org_article_e5eefbbd7479486c9b6903de50d6da77 |
| source | Open Access: PubMed Central; Publicly Available Content (ProQuest) |
| subjects | Adolescent Adult Age Factors Aged Ambulatory care Angioplasty Balloon treatment Benchmarking Catheterization Cohort analysis Databases, Factual Door-in to door-out (DIDO) EKG Electrocardiography Emergency Medical Services Emergency services Female Heart attacks Hospitals Humans Male Middle Aged Mortality Myocardial infarction Ontario Patient Transfer Patients Percutaneous Coronary Intervention - adverse effects Percutaneous Coronary Intervention - mortality Population Population studies Population-based studies Pre-hospital electrocardiogram (ECG) Primary percutaneous coronary intervention (PCI) Privacy Quality Improvement Quality Indicators, Health Care Retrospective Studies Risk Factors ST Elevation Myocardial Infarction - diagnostic imaging ST Elevation Myocardial Infarction - mortality ST Elevation Myocardial Infarction - surgery ST-segment elevation myocardial infarction (STEMI) Studies Time Factors Time-to-Treatment Treatment Outcome Young Adult |
| title | Factors associated with door-in to door-out delays among ST-segment elevation myocardial infarction (STEMI) patients transferred for primary percutaneous coronary intervention: a population-based cohort study in Ontario, Canada |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-22T19%3A16%3A26IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_doaj_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Factors%20associated%20with%20door-in%20to%20door-out%20delays%20among%20ST-segment%20elevation%20myocardial%20infarction%20(STEMI)%20patients%20transferred%20for%20primary%20percutaneous%20coronary%20intervention:%20a%20population-based%20cohort%20study%20in%20Ontario,%20Canada&rft.jtitle=BMC%20cardiovascular%20disorders&rft.au=Shi,%20Oumin&rft.date=2018-10-29&rft.volume=18&rft.issue=1&rft.spage=204&rft.epage=204&rft.pages=204-204&rft.artnum=204&rft.issn=1471-2261&rft.eissn=1471-2261&rft_id=info:doi/10.1186/s12872-018-0940-z&rft_dat=%3Cproquest_doaj_%3E2135048686%3C/proquest_doaj_%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c423t-f89a6ed3e02346d61af87e1d74772dfaeecdd5a83076890949c618f9e74e1b983%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2135048686&rft_id=info:pmid/30373536&rfr_iscdi=true |