From Door‐to‐Balloon Time to Contact‐to‐Device Time: Predictors of Achieving Target Times in Patients With ST‐Elevation Myocardial Infarction

Background The 2013 American College of Cardiology Foundation/American Heart Association ST‐segment elevation myocardial infarction (STEMI) guidelines have shifted focus from door‐to‐balloon (D2B) time to the time from first medical contact to device activation (contact‐to‐device time [C2D] ). Hypot...

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Bibliographic Details
Published in:Clinical cardiology (Mahwah, N.J.) N.J.), 2014-07, Vol.37 (7), p.389-394
Main Authors: Roswell, Robert O., Greet, Brian, Parikh, Parin, Mignatti, Andrea, Freese, John, Lobach, Iryna, Guo, Yu, Keller, Norma, Radford, Martha, Bangalore, Sripal
Format: Article
Language:English
Subjects:
Aged
Cardiology
Chi-Square Distribution
Confidence intervals
Electrocardiography - standards
Emergency Medical Services - methods
Emergency Medical Services - standards
Female
Heart attacks
Humans
Linear Models
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction - diagnosis
Myocardial Infarction - therapy
New York City
Odds Ratio
Percutaneous Coronary Intervention - instrumentation
Percutaneous Coronary Intervention - standards
Practice Guidelines as Topic
Predictive Value of Tests
Prospective Studies
Quality and Outcomes
Retrospective Studies
Time Factors
Time-to-Treatment
Treatment Outcome
Wireless Technology - standards
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Summary:Background The 2013 American College of Cardiology Foundation/American Heart Association ST‐segment elevation myocardial infarction (STEMI) guidelines have shifted focus from door‐to‐balloon (D2B) time to the time from first medical contact to device activation (contact‐to‐device time [C2D] ). Hypothesis This study investigates the impact of prehospital wireless electrocardiogram transmission (PHT) on reperfusion times to assess the impact of the new guidelines. Methods From January 2009 to December 2012, data were collected on STEMI patients who received percutaneous coronary interventions; 245 patients were included for analysis. The primary outcome was median C2D time in the PHT group and the secondary outcome was D2B time. Results Prehospital wireless electrocardiogram transmission was associated with reduced C2D times vs no PHT: 80 minutes (interquartile range [IQR], 64–94) vs 96 minutes (IQR, 79—118), respectively, P < 0.0001. The median D2B time was lower in the PHT group vs the no‐PHT group: 45 minutes (IQR, 34–56) vs 63 minutes (IQR, 49–81), respectively, P < 0.0001. Multivariate analysis showed PHT to be the strongest predictor of a C2D time of
ISSN:0160-9289
1932-8737
DOI:10.1002/clc.22278