Shorter Door-to-ECG Time Is Associated with Improved Mortality in STEMI Patients

Delayed intervention for ST-segment elevation myocardial infarction (STEMI) is associated with higher mortality. The association of door-to-ECG (D2E) with clinical outcomes has not been directly explored in a contemporary US-based population. This was a three-year, 10-center, retrospective cohort st...

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Bibliographic Details
Published in:Journal of clinical medicine 2024-05, Vol.13 (9), p.2650
Main Authors: Yiadom, Maame Yaa A B, Gong, Wu, Bloos, Sean M, Bunney, Gabrielle, Kabeer, Rana, Pasao, Melissa A, Rodriguez, Fatima, Baugh, Christopher W, Mills, Angela M, Gavin, Nicholas, Podolsky, Seth R, Salazar, Gilberto A, Patterson, Brian, Mumma, Bryn E, Tanski, Mary E, Liu, Dandan
Format: Article
Language:English
Subjects:
California
Cardiology
Care and treatment
Data collection
Diagnosis
Doors
Electrocardiogram
Electrocardiography
Electronic health records
Emergency medical care
Evidence-based medicine
Heart attack
Heart failure
Hospitals
Intervention
Intubation
Ischemia
Medical imaging
Medical research
Medicine, Experimental
Mortality
Patient outcomes
Patients
Variables
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Summary:Delayed intervention for ST-segment elevation myocardial infarction (STEMI) is associated with higher mortality. The association of door-to-ECG (D2E) with clinical outcomes has not been directly explored in a contemporary US-based population. This was a three-year, 10-center, retrospective cohort study of ED-diagnosed patients with STEMI comparing mortality between those who received timely (10 min) diagnostic ECG. Among survivors, we explored left ventricular ejection fraction (LVEF) dysfunction during the STEMI encounter and recovery upon post-discharge follow-up. Mortality was lower among those who received a timely ECG where one-week mortality was 5% (21/420) vs. 10.2% (26/256) among those with untimely ECGs ( = 0.016), and in-hospital mortality was 6.0% (25/420) vs. 10.9% (28/256) ( = 0.028). Data to compare change in LVEF metrics were available in only 24% of patients during the STEMI encounter and 46.5% on discharge follow-up. D2E within 10 min may be associated with a 50% reduction in mortality among ED STEMI patients. LVEF dysfunction is the primary resultant morbidity among STEMI survivors but was infrequently assessed despite low LVEF being an indication for survival-improving therapy. It will be difficult to assess the impact of STEMI care interventions without more consistent LVEF assessment.
ISSN:2077-0383
2077-0383
DOI:10.3390/jcm13092650