Impact of pre‐hospital electrocardiograms on time to treatment and one year outcome in a rural regional ST‐segment elevation myocardial infarction network

Background Pre‐hospital electrocardiograms (ECGs) are believed to reduce time to reperfusion in ST Segment Elevation Myocardial Infarction (STEMI) patients. Little is known of their impact on clinical outcomes in a rural setting. Geisinger regional STEMI network provides percutaneous coronary interv...

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Bibliographic Details
Published in:Catheterization and cardiovascular interventions 2017-02, Vol.89 (2), p.245-251
Main Authors: Kahlon, Talwinder S., Barn, Kulpreet, Akram, Mian Muhammad Ali, Blankenship, James C., Bower‐Stout, Cinde, Carey, Dave J., Sun, Haiyan, Tompkins Weber, Karen, Skelding, Kimberly A., Scott, Thomas D., Green, Sandy M., Berger, Peter B.
Format: Article
Language:English
Subjects:
Aged
Ambulances
Catchment Area (Health)
Chi-Square Distribution
Delivery of Health Care, Integrated
Electrocardiography
Emergency Medical Services - methods
emergency medical system
EMS
Female
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Odds Ratio
PCI
Pennsylvania
percutaneous coronary intervention
Percutaneous Coronary Intervention - adverse effects
Percutaneous Coronary Intervention - mortality
Predictive Value of Tests
Retrospective Studies
Risk Factors
Rural Health Services
ST Elevation Myocardial Infarction - diagnosis
ST Elevation Myocardial Infarction - mortality
ST Elevation Myocardial Infarction - physiopathology
ST Elevation Myocardial Infarction - therapy
ST segment elevation myocardial infarction
STEMI
Time Factors
Time-to-Treatment
Treatment Outcome
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Summary:Background Pre‐hospital electrocardiograms (ECGs) are believed to reduce time to reperfusion in ST Segment Elevation Myocardial Infarction (STEMI) patients. Little is known of their impact on clinical outcomes in a rural setting. Geisinger regional STEMI network provides percutaneous coronary intervention (PCI) care to over a 100‐mile radius in rural central Pennsylvania. Methods A retrospective analysis identified 280 consecutive STEMI patients treated with PCI between 1/1/09 and 8/31/11. Comparison between two STEMI groups was performed: 205 patients who were taken by the emergency medical system (EMS) to the nearest hospital (a non‐PCI center), underwent an ECG revealing a STEMI, and were transported immediately to Geisinger Medical Center (GMC) for PCI (transfer group) versus 75 patients in whom a pre‐hospital ECG was obtained and who were transported by EMS directly to Geisinger for PCI, bypassing the nearest hospital that did not perform PCI (the pre‐hospital ECG group). Results Analysis of baseline characteristics revealed that the pre‐hospital ECG cohort was older (65 vs. 60 years); had a higher percentage of previous myocardial infarctions (MI) (28% vs. 15%), heart failure (11% vs. 4%), and prior PCI (23% vs. 13%; p 
ISSN:1522-1946
1522-726X
DOI:10.1002/ccd.26567