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Herscovici DM, Boggs KM, Cash RE, Espinola JA, Sullivan AF, Hasegawa K, Nagurney JT, Camargo CA. Development of a unified national database of primary percutaneous coronary intervention centers with co-located emergency departments, 2020. Am Heart J 2022; 254:149-155. [PMID: 36099978 DOI: 10.1016/j.ahj.2022.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 08/18/2022] [Accepted: 08/21/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Although primary percutaneous coronary intervention (pPCI) is the preferred intervention for ST-elevation myocardial infarction (STEMI), not all patients are admitted directly to an emergency department (ED) with 24/7/365 pPCI capabilities. This is partly due to a lack of a national system of known pPCI-capable EDs. Our objective was to create a unified, national database of confirmed 24/7/365 pPCI centers co-located in hospitals with EDs. METHODS We compiled all hospitals designated as Chest Pain Centers with Primary PCI by the American College of Cardiology's (ACC) National Clinical Data Registry (NCDR), all STEMI Receiving Centers designated by the American Heart Association's (AHA) Mission: Lifeline registry, and all state-designated pPCI-capable hospitals and designation criteria from state departments of health. We matched ACC, AHA, and state-designated facilities to those in the 2019 National ED Inventory (NEDI)-USA database to identify all EDs in pPCI-capable hospitals. RESULTS Overall, 467 hospitals were recognized as Chest Pain Centers with Primary PCI by ACC, 293 hospitals were recognized as being STEMI Receiving Centers by AHA, and 827 hospitals were confirmed to be pPCI-capable by state designations and operated 24/7/365. Together, there were 1,178 EDs (21% of 5,587 total) co-located in pPCI-capable hospitals operating 24/7/365. CONCLUSIONS There is substantial heterogeneity in cardiac systems of care, with large regional systems existing alongside local state-led initiatives. We created a unified national database of confirmed 24/7/365 pPCI centers co-located in hospitals with EDs. This data set will be valuable for future cardiac systems research and improving access to pPCI.
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Affiliation(s)
- Darya M Herscovici
- From the Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Krislyn M Boggs
- From the Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Rebecca E Cash
- From the Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Janice A Espinola
- From the Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Ashley F Sullivan
- From the Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Kohei Hasegawa
- From the Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - John T Nagurney
- From the Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Carlos A Camargo
- From the Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
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French WJ, Gunderson M, Travis D, Bieniarz M, Zegre‐Hemsey J, Goyal A, Jacobs AK. Emergency Interhospital Transfer of Patients With ST-Segment-Elevation Myocardial Infarction: Call 9-1-1-The American Heart Association Mission: Lifeline Program. J Am Heart Assoc 2022; 11:e026700. [PMID: 36370009 PMCID: PMC9750065 DOI: 10.1161/jaha.122.026700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022]
Abstract
The American Heart Association Mission: Lifeline program objectives are to improve the quality of care and outcomes for patients with ST-segment-elevation myocardial infarction. Every minute of delay in treatment adversely affects 1-year mortality. Transfer of patients safely and timely to hospitals with primary percutaneous coronary intervention capability is needed to improve outcomes. But treatment times continue to show delays, especially during interhospital transfers. A simple 3-step process of an interhospital "Call 9-1-1" protocol may expedite this process. This STAT TRANSFER process uses a systems approach that considers diverse ways in which patients access care, how EMS responds and determines destinations, how referring hospital transfers are performed, urban and rural differences, and how receiving hospitals prepare for an incoming patient with ST-segment-elevation myocardial infarction. This initiative suggests a strategy to reduce variability in interhospital transfer times using a STAT TRANSFER and a Call 9-1-1 process in a system of care that involves all stakeholders.
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Affiliation(s)
- William J. French
- Geffen School of Medicine at UCLA, Cardiac Catheterization Laboratory, Harbor‐UCLA Medical CenterTorranceCA
| | - Mic Gunderson
- Center for Systems Improvement, Cambridge Consulting Group; Emergency Health ServicesUniversity of MarylandBaltimore CountyMD
| | - David Travis
- EMS ProgramsHillsborough Community CollegeTampaFL
| | - Mark Bieniarz
- New Mexico Heart InstituteLovelace Medical CenterAlbuquerqueNM
| | - Jessica Zegre‐Hemsey
- School of Nursing; Department of Emergency MedicineThe University of North Carolina at Chapel HillNC
| | - Abhinav Goyal
- Emory Heart and Vascular Center, Emory Healthcare; Medicine (Cardiology)Emory School of Medicine; Emory Rollins School of Public HealthAtlantaGA
| | - Alice K. Jacobs
- Department of MedicineBoston University School of Medicine and Boston Medical CenterBostonMA
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Choudhry S, Carleton L, Eilbert W. Man with chest pain. J Am Coll Emerg Physicians Open 2022; 3:e12787. [PMID: 36016967 PMCID: PMC9396972 DOI: 10.1002/emp2.12787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/28/2022] [Indexed: 12/04/2022] Open
Affiliation(s)
- Saba Choudhry
- Department of Emergency MedicineJesse Brown Veterans Administration Medical CenterCollege of MedicineUniversity of IllinoisChicagoIllinoisUSA
| | - Lena Carleton
- Department of Emergency MedicineCollege of MedicineUniversity of IllinoisChicagoIllinoisUSA
| | - Wesley Eilbert
- Department of Emergency MedicineCollege of MedicineUniversity of IllinoisChicagoIllinoisUSA
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Combined therapy with dapagliflozin and entresto offers an additional benefit on improving the heart function in rat after ischemia-reperfusion injury. Biomed J 2022; 46:100546. [PMID: 35718305 DOI: 10.1016/j.bj.2022.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/29/2022] [Accepted: 06/11/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study tested whether combined dapagliflozin and entresto treatment would be superior to either one alone for preserving the left-ventricular ejection-fraction (LVEF) in rat after ischemia-reperfusion (IR) injury. METHODS AND RESULTS In vitro flow-cytometric result showed that the intracellular and mitochondrial reactive oxygen species and mitochondrial permeability transition pore, and protein levels of oxidative-stress/DNA-damaged markers [NADPH-oxidase-1 (NOX-1)/NOX-2/oxidized-protein/γ-H2A-histone-family member X (γ-H2AX)] were significantly higher in hydrogen peroxide (H2O2) (300μM)-treated H9C2 cells as compared with the controls that were significantly reversed in sacubitril/valsartan and dapagliflozin therapy in the same H2O2-treated condition, whereas the protein expressions of antioxidants [Sirtuin-1 (SIRT1)/SIRT3/superoxide dismutase/catalase/glutathione peroxidase) exhibited an opposite pattern among the groups (all p<0.001). Adult-male-Sprague-Dawley rat (n=40) were equally categorized into group 1 (sham-operated control), group 2 (IR), group 3 (IR+dapagliflozin/20mg/kg/orally at 3h and post-days 1/2/3 after IR), group 4 (IR+entresto/100mg/kg/orally at 3h and post-days 1/2/3 after IR) and group 5 (IR+dapagliflozin+entresto) and the hearts were harvested by day 3 after IR. The 3rd day's LVEF was highest in group 1, lowest in group 2 and significantly higher in group 5 than in groups 3/4, but it was similar between the latter two groups (p<0.001). The protein expressions of oxidative-stress (NOX-1/NOX-2/oxidized protein), fibrotic (transforming-growth factor-ß/phosphorylated-Smad3), apoptotic [mitochondrial-Bax/cleaved-caspase-3/cleaved-poly (ADP-ribose) polymerase], mitochondria/DNA damaged (cytosolic-cytochrome-C/γ-H2AX), pressure-overload/heart-failure [brain natriuretic peptide (BNP)/ß-myosin heavy chain] and autophagic (ratio of meiotic cyclins CLB3-II/CLB3-I) biomarkers, and the upstream (high-mobility group box 1/Toll-like receptor-4/MyD88/phosphorylated-nuclear factor-κB and downstream [interleukin (IL)-1ß/IL-6/tumor necrosis factor-α] inflammatory signalings revealed an antithetical features of LVEF among the groups (all p<0.0001). The cellular levels of inflammatory (myeloperoxidase+/CD68+), pressure-overload/heart-failure (BNP+) and DNA-damage (γ-H2AX+) biomarkers as well as infarct area demonstrated an opposite pattern of LVEF among the groups (all p<0.0001). CONCLUSION Incorporated entresto-dapagliflozin treatment was superior to either one alone on protecting the heart against IR injury.
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Teixeira AB, Zancaner LF, Ribeiro FFDF, Pintyá JP, Schmidt A, Maciel BC, Marin JA, Miranda CH. Reperfusion Therapy Optimization in Acute Myocardial Infarction with ST-Segment Elevation using WhatsApp®-Based Telemedicine. Arq Bras Cardiol 2022; 118:556-564. [PMID: 35137785 PMCID: PMC8959040 DOI: 10.36660/abc.20201243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/22/2021] [Accepted: 03/24/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND About 40% of patients with ST-segment elevation myocardial infarction (STEMI) in Brazil do not receive reperfusion therapy. OBJECTIVE The use of a telemedicine network based on WhatsApp® could increase the percentage of patients receiving reperfusion therapy. METHODS A cross-sectional study analyzed outcomes before and after the organization of a telemedicine network to send the electrocardiogram via WhatsApp® of patients suspected of STEMI from 25 municipalities that are members of the Regional Health Department of Ribeirão Preto (DRS-XIII) to a tertiary hospital, which could authorize immediate patient transfer using the same system. The analyzed outcomes included the percentage of patients who received reperfusion therapy and the in-hospital mortality rate. A p value < 0.05 was considered statistically significant. RESULTS The study compared 82 patients before (February 1, 2016 to January 31, 2018) with 196 patients after this network implementation (February 1, 2018 to January 31, 2020). After implementing this network, there was a significant increase in the proportion of patients who received reperfusion therapy (60% vs. 92%), relative risk (RR): 1.594 [95% confidence interval (CI) 1.331 - 1.909], p < 0.0001 and decrease in the in-hospital mortality rate (13.4% vs. 5.6%), RR: 0.418 [95%CI 0.189 - 0.927], p = 0.028. CONCLUSION The use of WhatsApp®-based telemedicine has led to an increase in the percentage of patients with STEMI who received reperfusion therapy and a decrease in the in-hospital mortality rate.
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Affiliation(s)
- Alessandra Batista Teixeira
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoDivisão de Medicina de Emergência do Departamento de Clínica MédicaRibeirão PretoSPBrasilUniversidade de São Paulo Faculdade de Medicina de Ribeirão Preto - Divisão de Medicina de Emergência do Departamento de Clínica Médica,Ribeirão Preto, SP - Brasil
| | - Leonardo Fiaschi Zancaner
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoDivisão de Medicina de Emergência do Departamento de Clínica MédicaRibeirão PretoSPBrasilUniversidade de São Paulo Faculdade de Medicina de Ribeirão Preto - Divisão de Medicina de Emergência do Departamento de Clínica Médica,Ribeirão Preto, SP - Brasil
| | - Fernando Fonseca de França Ribeiro
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoCentro de CardiologiaRibeirão PretoSPBrasilUniversidade de São Paulo Faculdade de Medicina de Ribeirão Preto - Centro de Cardiologia,Ribeirão Preto, SP - Brasil
| | - José Paulo Pintyá
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoDivisão de Medicina de Emergência do Departamento de Clínica MédicaRibeirão PretoSPBrasilUniversidade de São Paulo Faculdade de Medicina de Ribeirão Preto - Divisão de Medicina de Emergência do Departamento de Clínica Médica,Ribeirão Preto, SP - Brasil
| | - André Schmidt
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoCentro de CardiologiaRibeirão PretoSPBrasilUniversidade de São Paulo Faculdade de Medicina de Ribeirão Preto - Centro de Cardiologia,Ribeirão Preto, SP - Brasil
| | - Benedito Carlos Maciel
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoCentro de CardiologiaRibeirão PretoSPBrasilUniversidade de São Paulo Faculdade de Medicina de Ribeirão Preto - Centro de Cardiologia,Ribeirão Preto, SP - Brasil
| | - José Antônio Marin
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoCentro de CardiologiaRibeirão PretoSPBrasilUniversidade de São Paulo Faculdade de Medicina de Ribeirão Preto - Centro de Cardiologia,Ribeirão Preto, SP - Brasil
| | - Carlos Henrique Miranda
- Universidade de São PauloFaculdade de Medicina de Ribeirão PretoDivisão de Medicina de Emergência do Departamento de Clínica MédicaRibeirão PretoSPBrasilUniversidade de São Paulo Faculdade de Medicina de Ribeirão Preto - Divisão de Medicina de Emergência do Departamento de Clínica Médica,Ribeirão Preto, SP - Brasil
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Sturm RC, Jones TL, Youngquist ST, Shah RU. Regional Systems of Care in ST Elevation Myocardial Infarction. Interv Cardiol Clin 2021; 10:281-291. [PMID: 34053615 DOI: 10.1016/j.iccl.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
ST-segment elevation myocardial infarction is a medical emergency with significant health care delivery challenges to ensure rapid triage and treatment. Several developments over the past decades have led to improved care delivery, decreased time to reperfusion, and decreased mortality. Still, significant challenges remain to further optimize the delivery of care for this patient population.
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Affiliation(s)
- Robert C Sturm
- Division of Cardiovascular Medicine, University of Utah, 30 N. 1900 E, Room 4A100, Salt Lake City, UT, 84132, USA.
| | - Tara L Jones
- Division of Cardiovascular Medicine, University of Utah, 30 N. 1900 E, Room 4A100, Salt Lake City, UT, 84132, USA
| | - Scott T Youngquist
- Division of Emergency Medicine, University of Utah, 30 N 1900 E 1C026, Salt Lake City, UT 84132, USA
| | - Rashmee U Shah
- Division of Cardiovascular Medicine, University of Utah, 30 N. 1900 E, Room 4A100, Salt Lake City, UT, 84132, USA
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Ingraham A, Reinke CE. Optimizing Safety for Surgical Patients Undergoing Interhospital Transfer. Surg Clin North Am 2020; 101:57-69. [PMID: 33212080 DOI: 10.1016/j.suc.2020.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Interhospital transfers play a key role in ensuring that patients receive necessary care. However, patients who are transferred between hospitals are a vulnerable population, and outcomes of transferred patients are suboptimal. Despite the critical nature of interhospital transfers, only limited effort has been dedicated to standardization and improvement of the transfer process. Studying and adapting quality improvement efforts directed at other transitions of care, particularly those that cross between different facilities and care teams "such as the transition from hospital to home or extended care facilities" may improve the care of surgical patients transferred between acute care institutions.
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Affiliation(s)
- Angela Ingraham
- Department of Surgery, University of Wisconsin-Madison, G5/342 CSC, 600 Highland Avenue, Madison, WI 53792, USA. https://twitter.com/AngieIngrahamMD
| | - Caroline E Reinke
- Department of Surgery, Carolinas Medical Center, Atrium Health, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA.
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Rokos IC. Artificial intelligence for STEMI detection: The "Shanghai Algorithm" provides a step forward. Int J Cardiol 2020; 317:231-232. [PMID: 32659291 DOI: 10.1016/j.ijcard.2020.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/01/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Ivan C Rokos
- Geffen School of Medicine at UCLA, Olive View-UCLA Hospital, Methodist Hospital of Arcadia, Los Angeles, CA, United States of America.
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2019 Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology Guidelines on the Acute Management of ST-Elevation Myocardial Infarction: Focused Update on Regionalization and Reperfusion. Can J Cardiol 2019; 35:107-132. [PMID: 30760415 DOI: 10.1016/j.cjca.2018.11.031] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/29/2018] [Accepted: 11/29/2018] [Indexed: 12/15/2022] Open
Abstract
Rapid reperfusion of the infarct-related artery is the cornerstone of therapy for the management of acute ST-elevation myocardial infarction (STEMI). Canada's geography presents unique challenges for timely delivery of reperfusion therapy for STEMI patients. The Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology STEMI guideline was developed to provide advice regarding the optimal acute management of STEMI patients irrespective of where they are initially identified: in the field, at a non-percutaneous coronary intervention-capable centre or at a percutaneous coronary intervention-capable centre. We had also planned to evaluate and incorporate sex and gender considerations in the development of our recommendations. Unfortunately, inadequate enrollment of women in randomized trials, lack of publication of main outcomes stratified according to sex, and lack of inclusion of gender as a study variable in the available literature limited the feasibility of such an approach. The Grading Recommendations, Assessment, Development, and Evaluation system was used to develop specific evidence-based recommendations for the early identification of STEMI patients, practical aspects of patient transport, regional reperfusion decision-making, adjunctive prehospital interventions (oxygen, opioids, antiplatelet therapy), and procedural aspects of mechanical reperfusion (access site, thrombectomy, antithrombotic therapy, extent of revascularization). Emphasis is placed on integrating these recommendations as part of an organized regional network of STEMI care and the development of appropriate reperfusion and transportation pathways for any given region. It is anticipated that these guidelines will serve as a practical template to develop systems of care capable of providing optimal treatment for a wide range of STEMI patients.
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Lange DC, Conte S, Pappas-Block E, Hildebrandt D, Nakamura M, Makkar R, Kar S, Torbati S, Geiderman J, McNeil N, Cercek B, Tabak SW, Rokos I, Henry TD. Cancellation of the Cardiac Catheterization Lab After Activation for ST-Segment-Elevation Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2019; 11:e004464. [PMID: 30354373 DOI: 10.1161/circoutcomes.117.004464] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Prehospital ECG-based cardiac catheterization laboratory (CCL) activation for ST-segment-elevation myocardial infarction reduces door-to-balloon times, but CCL cancellations (CCLX) remain a challenging problem. We examined the reasons for CCLX, clinical characteristics, and outcomes of patients presenting as ST-segment-elevation myocardial infarction activations who receive emergent coronary angiography (EA) compared with CCLX. METHODS AND RESULTS We reviewed all consecutive CCL activations between January 1, 2012, and December 31, 2014 (n=1332). Data were analyzed comparing 2 groups stratified as EA (n=466) versus CCLX (n=866; 65%). Reasons for CCLX included bundle branch block (21%), poor-quality prehospital ECG (18%), non-ST-segment-elevation myocardial infarction ST changes (18%), repolarization abnormality (13%), and arrhythmia (8%). A multivariate logistic regression model using age, peak troponin, and initial ECG findings had a high discriminatory value for determining EA versus CCLX (C statistic, 0.985). CCLX subjects were older and more likely to be women, have prior coronary artery bypass grafting, or a paced rhythm ( P<0.0001 for all). All-cause mortality did not differ between groups at 1 year or during the study period (mean follow-up, 2.186±1.167 years; 15.8% EA versus 16.2% CCLX; P=0.9377). Cardiac death was higher in the EA group (11.8% versus 3.0%; P<0.0001). After adjusting for clinical variables associated with survival, CCLX was associated with an increased risk for all-cause mortality during the study period (hazard ratio, 1.82; 95% CI, 1.28-2.59; P=0.0009). CONCLUSIONS In this study, prehospital ECG without overreading or transmission lead to frequent CCLX. CCLX subjects differ with regard to age, sex, risk factors, and comorbidities. However, CCLX patients represent a high-risk population, with frequently positive cardiac enzymes and similar short- and long-term mortality compared with EA. Further studies are needed to determine how quality improvement initiatives can lower the rates of CCLX and influence clinical outcomes.
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Affiliation(s)
- David C Lange
- The Permanente Medical Group, Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA (D.C.L.)
| | - Stanley Conte
- Cedars-Sinai Heart Institute (S.C., E.P.-B., D.H., M.N., R.M., S.K., B.C., S.W.T., T.D.H.)
| | - Effie Pappas-Block
- Cedars-Sinai Heart Institute (S.C., E.P.-B., D.H., M.N., R.M., S.K., B.C., S.W.T., T.D.H.)
| | - David Hildebrandt
- Cedars-Sinai Heart Institute (S.C., E.P.-B., D.H., M.N., R.M., S.K., B.C., S.W.T., T.D.H.)
| | - Mamoo Nakamura
- Cedars-Sinai Heart Institute (S.C., E.P.-B., D.H., M.N., R.M., S.K., B.C., S.W.T., T.D.H.)
| | - Raj Makkar
- Cedars-Sinai Heart Institute (S.C., E.P.-B., D.H., M.N., R.M., S.K., B.C., S.W.T., T.D.H.)
| | - Saibal Kar
- Cedars-Sinai Heart Institute (S.C., E.P.-B., D.H., M.N., R.M., S.K., B.C., S.W.T., T.D.H.)
| | - Sam Torbati
- Department of Emergency Medicine (S.T., J.G., N.M.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Joel Geiderman
- Department of Emergency Medicine (S.T., J.G., N.M.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Nathan McNeil
- Department of Emergency Medicine (S.T., J.G., N.M.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Bojan Cercek
- Cedars-Sinai Heart Institute (S.C., E.P.-B., D.H., M.N., R.M., S.K., B.C., S.W.T., T.D.H.)
| | - Steven W Tabak
- Cedars-Sinai Heart Institute (S.C., E.P.-B., D.H., M.N., R.M., S.K., B.C., S.W.T., T.D.H.)
| | - Ivan Rokos
- Department of Emergency Medicine, UCLA Olive View Medical Center, Los Angeles, CA (I.R.)
| | - Timothy D Henry
- Cedars-Sinai Heart Institute (S.C., E.P.-B., D.H., M.N., R.M., S.K., B.C., S.W.T., T.D.H.)
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Kim TH, Song KJ, Shin SD, Ro YS, Hong KJ, Park JH. Effect of Specialized Critical Care Transport Unit on Short-Term Mortality of Critically ILL Patients Undergoing Interhospital Transport. PREHOSP EMERG CARE 2019; 24:46-54. [PMID: 30998115 DOI: 10.1080/10903127.2019.1607959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To minimize risk and prevent harmful incidents during interhospital transport, the critical care transport unit service called Seoul Mobile Intensive Care Unit (SMICU) was organized and initiated its service within the city of Seoul. We sought to evaluate the effectiveness of critical care transport units on outcomes of critically ill patients undergoing interhospital transport in Seoul. Methods: A retrospective observational case-control study was designed to evaluate the effectiveness of critical care transport units on outcomes of critically ill patients undergoing interhospital transport. ED patients transported from other hospitals in Seoul during 2016 were identified in the National Emergency Department Information System (NEDIS) and according to use of the SMICU. One-to-one propensity matching was performed to balance covariates between groups. The association of SMICU transport on survival outcome was calculated in a multivariable logistic regression model. Results: Among 42,188 ED patients transported from other hospitals in 2016, 482 (1.1%) of patients were transported by SMICU. Patients transported by SMICU had a higher proportion of severe emergency disease and use of a mechanical ventilator. The adjusted odds ratio for 24-hour mortality after interhospital transport was 0.45 (95% CI: 0.26-0.81) in total cohort and was 0.34 (95% CI: 0.16-0.71) in a one-to-one propensity-matched cohort. Conclusions: Transport by specialized critical care transport unit for patients undergoing interhospital transport was associated with lower 24-hour mortality, demonstrating the benefits of the SMICU.
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Zhao R, Xu K, Li Y, Qiu M, Han Y. Percutaneous coronary intervention in patients with acute coronary syndrome in Chinese Military Hospitals, 2011-2014: a retrospective observational study of a national registry. BMJ Open 2018; 8:e023133. [PMID: 30361405 PMCID: PMC6224757 DOI: 10.1136/bmjopen-2018-023133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Interventional treatment of patients with acute coronary syndrome (ACS) is surging dramatically in China in recent years, whereas nationwide assessments of the quality of percutaneous coronary intervention (PCI) procedural performance and outcomes are scarce. We aimed to provide an updated and real-world overview of the performance of PCI in patients with ACS since 2011 in China after the China PEACE study from 2001 to 2011. METHODS In this cross-sectional study, data were extracted from the National Registry of Cardiovascular Intervention in Military Hospitals database to create a national sample of 144 659 patients with ACS undergoing PCI at 117 military hospitals in all regions of China from calendar years 2011-2014. Patient characteristics, procedural performance, PCI outcomes and adverse events and temporal changes were analysed. RESULTS During 2011-2014, patients with ACS undergoing PCI increased dramatically. Small numbers of high-volume hospitals performed the majority of PCI procedures. However, only half of these patients were adequately covered and proportions for the use of assisted devices and novel medications were relatively small. Radial artery access was still increasing with time. Primary PCIs were performed on 45.4% ST-segment elevation myocardial infarction patients with PCI procedures. 3.8% lesion vessels involve left main artery. Implanted stents, the overall complications and in-hospital mortality were decreasing remarkably. CONCLUSIONS In Chinese military hospitals, interventional resources were limited with great regional disparities, there are still gaps to be filled to better serve patients with ACS. Our findings can serve as an indispensable supplement to a more comprehensive understanding of the practice of contemporary cardiac intervention in China.
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Affiliation(s)
| | | | | | | | - Yaling Han
- Department of Cardiology, General Hospital of Shenyang Military Command, Shenyang, China
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Combined Therapy with SS31 and Mitochondria Mitigates Myocardial Ischemia-Reperfusion Injury in Rats. Int J Mol Sci 2018; 19:ijms19092782. [PMID: 30223594 PMCID: PMC6164143 DOI: 10.3390/ijms19092782] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/09/2018] [Accepted: 09/13/2018] [Indexed: 02/04/2023] Open
Abstract
Myocardial ischemia-reperfusion (IR) injury contributes to adverse cardiac outcomes after myocardial ischemia, cardiac surgery, or circulatory arrest. In this study, we evaluated the ability of combined SS31-mitochondria (Mito) therapy to protect heart cells from myocardial IR injury. Adult male SD rats (n = 8/each group) were randomized: group 1 (sham-operated control), group 2 (IR, 30-min ischemia/72 h reperfusion), group 3 (IR-SS31 (2 mg intra-peritoneal injection at 30 min/24 h/48 h after IR)), group 4 (IR-mitochondria (2 mg/derived from donor liver/intra-venous administration/30 min after IR procedure)), and group 5 (IR-SS31-mitochondria). In H9C2 cells, SS31 suppressed menadione-induced oxidative-stress markers (NOX-1, NOX-2, oxidized protein) while it increased SIRT1/SIRT3 expression and ATP levels. In adult male rats 72 h after IR, left ventricular ejection fraction (LVEF) was highest in sham-operated control animals and lowest in the IR group. LVEF was also higher in IR rats treated with SS31-Mito than untreated IR rats or those treated with Mito or SS31 alone. Areas of fibrosis/collagen-deposition showed the opposite pattern. Likewise, levels of oxidative-stress markers (NOX-1, NOX-2, oxidized protein), inflammatory markers (MMP-9, CD11, IL-1β, TNF-α), apoptotic markers (mitochondrial-Bax, cleaved-caspase-3, PARP), fibrosis markers (p-Smad3, TGF-β), DNA-damage (γ-H2AX), sarcomere-length, and pressure/volume overload markers (BNP, β-MHC) all showed a pattern opposite that of LVEF. Conversely, anti-apoptotic (BMP-2, Smad1/5) and energy integrity (PGC-1α/mitochondrial cytochrome-C) markers exhibited a pattern identical to that of LVEF. This study demonstrates that the combined SS31-Mito therapy is superior to either therapy alone for protecting myocardium from IR injury and indicates that the responsible mechanisms involved increased SIRT1/SIRT3 expression, which suppresses inflammation and oxidative stress and protects mitochondrial integrity.
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Decreased Time from 9-1-1 Call to PCI among Patients Experiencing STEMI Results in a Decreased One Year Mortality. PREHOSP EMERG CARE 2018; 22:669-675. [DOI: 10.1080/10903127.2018.1447621] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Wei J, Mehta PK, Grey E, Garberich RF, Hauser R, Bairey Merz CN, Henry TD. Sex-based differences in quality of care and outcomes in a health system using a standardized STEMI protocol. Am Heart J 2017; 191:30-36. [PMID: 28888267 DOI: 10.1016/j.ahj.2017.06.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 06/14/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Recent data from the National Cardiovascular Data Registry indicate that women with ST-segment-elevation myocardial infarction (STEMI) continue to have higher mortality and reported delays in treatment compared with men. We aimed to determine whether the sex difference in mortality exists when treatment disparities are reduced. METHODS Using a prospective regional percutaneous coronary intervention (PCI)-based STEMI system database with a standardized STEMI protocol, we evaluated baseline characteristics, treatment, and clinical outcomes of STEMI patients stratified by sex. RESULTS From March 2003 to January 2016, 4,918 consecutive STEMI patients presented to the Minneapolis Heart Institute at Abbott Northwestern Hospital regional STEMI system including 1,416 (28.8%) women. Compared with men, women were older (68.4 vs 60.9 years) with higher rates of hypertension (66.7% vs 55.7%), diabetes (21.7% vs 17.4%), and cardiogenic shock (11.5% vs 8.0%) (all P < .001). Pre-revascularization medications and PCI were performed with same frequencies, but women were less likely to receive statin or antiplatelet therapy at discharge. After age adjustment, women had similar in-hospital mortality to men (5.1% vs 4.8%, P = .60) despite slightly longer door-to-balloon time (95 vs 92 minutes, P = .004). Five-year follow-up confirmed absence of a sex disparity in age-adjusted survival post-STEMI. CONCLUSIONS Previously reported treatment disparities between men and women are diminished in a regional PCI-based STEMI system using a standardized STEMI protocol. No sex differences in short-term or long-term age-adjusted mortality are present in this registry despite some treatment disparities. These results suggest that STEMI health care disparities and mortality in women can be improved using STEMI protocols and systems.
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Affiliation(s)
- Janet Wei
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Puja K Mehta
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA; Emory Clinical Cardiovascular Research Institute, Emory University, Atlanta, GA
| | - Elizabeth Grey
- Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN
| | - Ross F Garberich
- Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN
| | - Robert Hauser
- Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN
| | - C Noel Bairey Merz
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Timothy D Henry
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
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Mehta S, Botelho R, Cade J, Perin M, Bojanini F, Coral J, Parra D, Ferré A, Castillo M, Yépez P. Global Challenges and Solutions: Role of Telemedicine in ST-Elevation Myocardial Infarction Interventions. Interv Cardiol Clin 2017; 5:569-581. [PMID: 28582005 DOI: 10.1016/j.iccl.2016.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Major disparities exist between developed and developing countries in the management of acute myocardial infarction (AMI). These pronounced differences result in significantly increased morbidity and mortality from AMI in different regions of the world. Lack of infrastructure, insurance, facilities, and skilled personnel are the major constraints. Primary percutaneous coronary intervention has revolutionized the treatment of AMI; however, its global use is limited by the listed constraints. Telemedicine provides an efficient methodology that can hugely increase access and accuracy of AMI management.
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Affiliation(s)
- Sameer Mehta
- Lumen Foundation, 185 Shore Drive South, Miami, FL 33133, USA.
| | - Roberto Botelho
- Lumen Foundation, 185 Shore Drive South, Miami, FL 33133, USA
| | - Jamil Cade
- Lumen Foundation, 185 Shore Drive South, Miami, FL 33133, USA
| | - Marco Perin
- Lumen Foundation, 185 Shore Drive South, Miami, FL 33133, USA
| | - Fredy Bojanini
- Lumen Foundation, 185 Shore Drive South, Miami, FL 33133, USA
| | - Juan Coral
- Lumen Foundation, 185 Shore Drive South, Miami, FL 33133, USA
| | - Daniela Parra
- Lumen Foundation, 185 Shore Drive South, Miami, FL 33133, USA
| | - Alexandra Ferré
- Lumen Foundation, 185 Shore Drive South, Miami, FL 33133, USA
| | - Marco Castillo
- Lumen Foundation, 185 Shore Drive South, Miami, FL 33133, USA
| | - Pablo Yépez
- Lumen Foundation, 185 Shore Drive South, Miami, FL 33133, USA
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Tanguay A, Brassard E, Lebon J, Bégin F, Hébert D, Paradis JM. Effectiveness of a Prehospital Wireless 12-Lead Electrocardiogram and Cardiac Catheterization Laboratory Activation for ST-Elevation Myocardial Infarction. Am J Cardiol 2017; 119:553-559. [PMID: 27939226 DOI: 10.1016/j.amjcard.2016.10.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/26/2016] [Accepted: 10/26/2016] [Indexed: 11/29/2022]
Abstract
The aim of the study was to determine the prevalence of false-positive and inappropriate cardiac catheterization laboratory (CCL) activation in patients suspected with ST-elevation myocardial infarction (STEMI) diverted to a percutaneous coronary intervention (PCI) facility after paramedics wireless 12-lead electrocardiogram transmission to an emergency physician at an online medical control center. This retrospective study collected data from medical records of patients with suspected STEMI from 2006 to 2014. It included demographics, coronaropathic risk factors, cardiac biomarkers, time from the first medical contact to treatment, and final diagnosis. Primary outcome was the rate of false-positive and inappropriate CCL activation. As secondary outcomes, we compared patient characteristics between cases of appropriate and inappropriate CCL activation, and we assessed the presence of cardiac biomarkers, time from first medical contact to start of PCI, and final diagnosis. Overall, 673 patients with suspected STEMI were included in the analysis. A total of 640 patients (95%) had coronarography, of which 10% (62 of 640) did not have a culprit coronary artery (false positive). Angiography was canceled for 5% (33 of 673) of patients. The total false-positive and inappropriate CCL activation rate was 14% (95 of 673). Average time from the first medical contact to the start of PCI was 47 ± 18.1 minutes. Unwanted CCL activations were more likely to involve men aged >65 years and patients with a history of coronary artery disease. In conclusion, our system of transmitted prehospital electrocardiography and STEMI interpretation by emergency physicians at an online medical control center showed a total false-positive and inappropriate CCL activation rate of 14% over the 8-year study period.
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Affiliation(s)
- Alain Tanguay
- Unité de Coordination Clinique des Services Préhospitaliers d'Urgences (UCCSPU), Québec, Québec, Canada; Centre de Recherche de l'Hôtel-Dieu de Lévis, Québec, Québec, Canada
| | - Eric Brassard
- Faculté de Médecine Université Laval, Québec, Québec, Canada
| | - Johann Lebon
- Unité de Coordination Clinique des Services Préhospitaliers d'Urgences (UCCSPU), Québec, Québec, Canada; Centre de Recherche de l'Hôtel-Dieu de Lévis, Québec, Québec, Canada.
| | - François Bégin
- Centre de Recherche de l'Hôtel-Dieu de Lévis, Québec, Québec, Canada; Faculté de Médecine Université Laval, Québec, Québec, Canada
| | - Denise Hébert
- Unité de Coordination Clinique des Services Préhospitaliers d'Urgences (UCCSPU), Québec, Québec, Canada
| | - Jean-Michel Paradis
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada
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Choi Y, Lee YJ, Shin SD, Song KJ, Lee K, Lee EJ, Kim YJ, Ahn KO, Hong KJ, Ro YS. The impact of recommended percutaneous coronary intervention care on hospital outcomes for interhospital-transferred STEMI patients. Am J Emerg Med 2016; 35:7-12. [PMID: 27771225 DOI: 10.1016/j.ajem.2016.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 08/21/2016] [Accepted: 09/14/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Timely transfer and percutaneous coronary intervention (PCI) with or without thrombolysis are recommended by the American Heart Association (AHA) to care for ST-segment elevation myocardial infarction (STEMI) patients who present first to a non-PCI-capable hospital. This study was to evaluate the impact on in-hospital mortality of the compliance with guidelines regarding to the time of PCI for patients with STEMI who were transferred to a capable PCI hospital. METHODS We used the CArdioVAscular disease Surveillance data from November 2007 to December 2012 for this study. Adult patients who were diagnosed with STEMI and transferred from a primary hospital for PCI were included. Patients who underwent PCI or coronary artery bypass graft surgery in the primary hospital and patients with an unknown emergency department disposition were excluded. The main exposure was the AHA recommendation for reperfusion therapy. We tested the association between compliance with AHA and hospital mortality. RESULTS A total of 2078 patients were analyzed, 30.0% of whom were treated in compliance with the guidelines, whereas the remaining 70.0% were not. Thrombolysis was performed in 7.9% and 0.8% (P value < .01) and hospital mortality was 5.0% and 6.8% (P value = .11) in the compliant and violence groups, respectively. The adjusted odds ratios (95% confidence intervals) of the compliant group for hospital mortality were 0.75 (0.46-1.21), respectively. A sensitivity analysis of symptom onset to arrival time was a trend for a beneficial effect in the compliant group. CONCLUSIONS Among the patients who were transferred for STEMI care, undergoing PCI as recommended by the AHA was not associated with a mortality benefit, but the patients whose symptom onset to hospital arrival time was within 30 minutes showed an association between compliance and lower mortality.
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Affiliation(s)
- YeongHo Choi
- Department of Emergency Medicine, Seoul National University College of Medicine.
| | - Yu Jin Lee
- Department of Emergency Medicine, National Medical Center.
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine.
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University College of Medicine.
| | - KyungWon Lee
- Department of Emergency Medicine, Seoul National University College of Medicine.
| | - Eui Jung Lee
- Department of Emergency Medicine, Seoul National University College of Medicine.
| | - Yu Jin Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Republic of Korea.
| | - Ki Ok Ahn
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute.
| | - Ki Jeong Hong
- Department of Emergency Medicine, Seoul National University College of Medicine; Seoul Metropolitan Government Seoul National University Boramae Medical Center.
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute.
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Assessment of Changing Patterns of Hematological Indices and Their Effects on the Success of Primary Percutaneous Reperfusion in Acute Transmural Myocardial Infarction. Res Cardiovasc Med 2016. [DOI: 10.5812/cardiovascmed.34146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Musey PI, Studnek JR, Garvey L. Characteristics of ST Elevation Myocardial Infarction Patients Who Do Not Undergo Percutaneous Coronary Intervention After Prehospital Cardiac Catheterization Laboratory Activation. Crit Pathw Cardiol 2016; 15:16-21. [PMID: 26881815 DOI: 10.1097/hpc.0000000000000069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To assess the clinical and electrocardiographic characteristics of patients diagnosed with ST elevation myocardial infarction (STEMI) that are associated with an increased likelihood of not undergoing percutaneous coronary intervention (PCI) after prehospital Cardiac Catheterization Laboratory activation in a regional STEMI system. METHODS We performed a retrospective analysis of prehospital Cardiac Catheterization Laboratory activations in Mecklenburg County, North Carolina, between May 2008 and March 2011. Data were extracted from the prehospital patient record, the prehospital electrocardiogram, and the regional STEMI database. The independent variables of interest included objective patient characteristics as well as documented cardiac history and risk factors. Analysis was performed using descriptive statistics and logistic regression. RESULTS Two hundred thirty-one prehospital activations were included in the analysis. Five independent variables were found to be associated with an increased likelihood of not undergoing PCI: increasing age, bundle branch block, elevated heart rate, left ventricular hypertrophy, and non-white race. The variables with the most significance were any type of bundle branch block [adjusted odds ratios (AOR), 5.66; 95% confidence interval (CI), 1.91-16.76], left ventricular hypertrophy (AOR, 4.63; 95% CI, 2.03-10.53), and non-white race (AOR, 3.53; 95% CI, 1.76-7.08). Conversely, the only variable associated with a higher likelihood of undergoing PCI was the presence of arm pain (AOR, 2.94; 95% CI, 1.36-6.25). CONCLUSIONS Several of the above variables are expected electrocardiogram mimics; however, the decreased rate of PCI in non-white patients highlights an area for investigation and process improvement. This may guide the development of prehospital STEMI protocols, although avoiding false positive and inappropriate activations.
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Affiliation(s)
- Paul I Musey
- From the *Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN; †Mecklenburg Emergency Medical Services Agency, Charlotte, NC; and ‡Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC
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Bansal E, Dhawan R, Wagman B, Low G, Zheng L, Chan L, Newton K, Swadron SP, Testa N, Shavelle DM. Importance of hospital entry: walk-in STEMI and primary percutaneous coronary intervention. West J Emerg Med 2015; 15:81-7. [PMID: 24578769 PMCID: PMC3935790 DOI: 10.5811/westjem.2013.9.17855] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 07/09/2013] [Accepted: 09/04/2013] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Patients with ST elevation myocardial infarction (STEMI) require rapid identification and triage to initiate reperfusion therapy. Walk-in STEMI patients have longer treatment times compared to emergency medical service (EMS) transported patients. While effective triage of large numbers of critically ill patients in the emergency department is often cited as the reason for treatment delays, additional factors have not been explored. The purpose of this study was to evaluate baseline demographic and clinical differences between walk-in and EMS-transported STEMI patients and identify factors associated with prolonged door to balloon (D2B) time in walk-in STEMI patients. METHODS We performed a retrospective review of 136 STEMI patients presenting to an urban academic teaching center from January 2009 through December 2010. Baseline demographics, mode of hospital entry (walk-in versus EMS transport), treatment times, angiographic findings, procedures performed and in-hospital clinical events were collected. We compared walk-in and EMS-transported STEMI patients and identified independent factors of prolonged D2B time for walk-in patients using stepwise logistic regression analysis. RESULTS Walk-in patients (n=51) were more likely to be Latino and presented with a higher heart rate, higher systolic blood pressure, prior history of diabetes mellitus and were more likely to have an elevated initial troponin value, compared to EMS-transported patients. EMS-transported patients (n=64) were more likely to be white and had a higher prevalence of left main coronary artery disease, compared to walk-in patients. Door to electrocardiogram (ECG), ECG to catheterization laboratory (CL) activation and D2B times were significantly longer for walk-in patients. Walk-in patients were more likely to have D2B time >90 minutes, compared to EMS- transported patients; odds ratio 3.53 (95% CI 1.03, 12.07), p=0.04. Stepwise logistic regression identified hospital entry mode as the only independent predictor for prolonged D2B time. CONCLUSION Baseline differences exist between walk-in and EMS-transported STEMI patients undergoing primary percutaneous coronary intervention (PCI). Hospital entry mode was the most important predictor for prolonged treatment times for primary PCI, independent of age, Latino ethnicity, heart rate, systolic blood pressure and initial troponin value. Prolonged door to ECG and ECG to CL activation times are modifiable factors associated with prolonged treatment times in walk-in STEMI patients. In addition to promoting the use of EMS transport, efforts are needed to rapidly identify and expedite the triage of walk-in STEMI patients.
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Affiliation(s)
- Eric Bansal
- Division of Cardiovascular Medicine, University of Southern California, Los Angeles, California
| | - Rahul Dhawan
- Division of Cardiovascular Medicine, University of Southern California, Los Angeles, California
| | - Brittany Wagman
- Office of Biostatistics and Outcomes Assessment, Los Angeles County + University of Southern California Medical Center, Los Angeles, California
| | - Garren Low
- Office of Biostatistics and Outcomes Assessment, Los Angeles County + University of Southern California Medical Center, Los Angeles, California
| | - Ling Zheng
- Department of Neurology, University of Southern California, Los Angeles, California
| | - Linda Chan
- Office of Biostatistics and Outcomes Assessment, Los Angeles County + University of Southern California Medical Center, Los Angeles, California
| | - Kim Newton
- Department of Emergency Medicine, University of Southern California, Los Angeles, California
| | - Stuart P Swadron
- Department of Emergency Medicine, University of Southern California, Los Angeles, California
| | - Nicholas Testa
- Department of Emergency Medicine, University of Southern California, Los Angeles, California
| | - David M Shavelle
- Division of Cardiovascular Medicine, University of Southern California, Los Angeles, California
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Chua S, Lee FY, Tsai TH, Sheu JJ, Leu S, Sun CK, Chen YL, Chang HW, Chai HT, Liu CF, Lu HI, Yip HK. Inhibition of dipeptidyl peptidase-IV enzyme activity protects against myocardial ischemia-reperfusion injury in rats. J Transl Med 2014; 12:357. [PMID: 25496837 PMCID: PMC4301397 DOI: 10.1186/s12967-014-0357-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Accepted: 12/04/2014] [Indexed: 11/10/2022] Open
Abstract
Background We investigated whether attenuating dipeptidyl peptidase-IV (DPP4) enzyme activity protected rat heart from ischemia-reperfusion (IR) injury (40-min left anterior descending coronary artery ligation followed by 72 h reperfusion). Methods and results Adult male Fischer 344 rats (n = 24) were equally divided into sham-control (WT-SC), WT-IR, and WT-IR-Sita (oral sitagliptin 400 mg/kg/day for 3 days) groups, whereas adult male DPP4-deficiency (DPP4D) rats (n = 16) were equally divided into DPP4D-SC and DPP4D-IR groups. Animals were sacrificed at 72 h after reperfusion with collection of heart specimens. Infarct area (H&E), collagen deposition (Sirius-red stain), fibrotic area (Masson's trichrome), and fluorescent-ROS intensity (H2DCFDA-labeling myocardium) of left ventricle were significantly higher in WT-IR than those in other groups, significantly higher in WT-IR-Sita and DPP4D-IR groups than in WT-SC and DPP4D-SC groups (all p < 0.001), but there was no difference between the latter two groups. Protein expressions of oxidative stress (oxidized protein), reactive oxygen species (NOX-1, NOX-2), inflammation (TNF-α, NF-κB, MMP-9, VCAM-1), apoptosis (mitochondrial Bax, cleaved caspase-3 and PARP), myocardial damage markers (cytosolic cytochrome-C, γ-H2AX), and number of inflammatory cells (CD14+, CD68+, CD40+ cells) showed a pattern identical to that of histological changes among all groups (all p < 0.005), whereas markers of anti-apoptosis (Bcl-2) and mitochondrial integrity (mitochondrial cytochrome-C) as well as left ventricular ejection fraction showed an opposite pattern (all p < 0.001). Protein expressions of anti-oxidants (HO-1, NQO-1), angiogenesis factors (SDF-1α, CXCR4), and glycogen-like-peptide-1-receptor were significantly higher inWT-IR-Sita and DPP4D-IR than those in other groups (all p < 0.001). Conclusion Abrogation of DPP4 activity protects against myocardial IR injury and preserved heart function.
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Paramedic specialization: a strategy for better out-of-hospital care. Air Med J 2014; 33:265-73. [PMID: 25441518 DOI: 10.1016/j.amj.2014.07.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 07/25/2014] [Indexed: 11/23/2022]
Abstract
Demographic, economic, and political forces are driving significant change in the US health care system. Paramedics are a health profession currently providing advanced emergency care and medical transportation throughout the United States. As the health care system demands more team-based care in nonacute, community, interfacility, and tactical response settings, specialized paramedic practitioners could be a valuable and well-positioned resource to meet these needs. Currently, there is limited support for specialty certifications that demand appropriate education, training, or experience standards before specialized practice by paramedics. A fragmented approach to specialty paramedic practice currently exists across our country in which states, regulators, nonprofit organizations, and other health care professions influence and regulate the practice of paramedicine. Multiple other medical professions, however, have already developed effective systems over the last century that can be easily adapted to the practice of paramedicine. Paramedicine practitioners need to organize a profession-based specialty board to organize and standardize a specialty certification system that can be used on a national level.
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Minha S, Loh JP, Satler LF, Pendyala LK, Barbash IM, Magalhaes MA, Suddath WO, Pichard AD, Torguson R, Waksman R. Transfer distance effect on reperfusion: timeline of ST-elevation patients transferred for primary percutaneous coronary intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2014; 15:369-74. [DOI: 10.1016/j.carrev.2014.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 08/07/2014] [Indexed: 11/25/2022]
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Nippak PMD, Pritchard J, Horodyski R, Ikeda-Douglas CJ, Isaac WW. Evaluation of a regional ST-elevation myocardial infarction primary percutaneous coronary intervention program at the Rouge Valley Health System. BMC Health Serv Res 2014; 14:449. [PMID: 25269747 PMCID: PMC4263118 DOI: 10.1186/1472-6963-14-449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 09/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND ST-elevation myocardial infarction (STEMI) remains the second leading cause of death in Canada. Primary percutaneous coronary intervention (PCI) has been recognized as an effective method for treating STEMI. Improved access to primary PCI can be achieved through the implementation of regional PCI centres, which was the impetus for implementing the PCI program in an east Toronto hospital in 2009. As such, the purpose of this study was to measure the efficacy of this program regional expansion. METHODS A retrospective review of 101 patients diagnosed with STEMI from May to Sept 2010 was conducted. The average door-to-balloon time for these STEMI patients was calculated and the door-to-balloon times using different methods of arrival were analyzed. Method of arrival was by one of three ways: paramedic initiated referral; patient walk-ins to PCI centre emergency department; or transfer after walk-in to community hospital emergency department. RESULTS The study found that mean door-to balloon time for PCI was 112.5 minutes. When the door-to-balloon times were compared across the three arrival methods, patients who presented by paramedic-initiated referral had significantly shorter door-to-balloon times, (89.5 minutes) relative to those transferred (120.9 minutes) and those who walked into a PCI centre (126.7 minutes) (p = 0.047). CONCLUSIONS The findings suggest that the partnership between the hospital and its EMS partners should be continued, and paramedic initiated referral should be expanded across Canada and EMS systems where feasible, as this level of coverage does not currently exist nationwide. Investments in regional centres of excellence and the creation of EMS partnerships are needed to enhance access to primary PCI.
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Affiliation(s)
- Pria M D Nippak
- Health Services Management Department, Ryerson University, 350 Victoria St, Toronto, ON M2K 5B3, Canada.
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Brunetti ND, Dellegrottaglie G, Di Giuseppe G, Di Biase M. Remote tele-medicine cardiologist support for care manager nursing of chronic cardiovascular disease: preliminary report. Int J Cardiol 2014; 176:552-6. [DOI: 10.1016/j.ijcard.2014.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 07/05/2014] [Indexed: 11/26/2022]
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Kristensen SD, Laut KG, Kaifoszova Z, Widimsky P. Variable penetration of primary angioplasty in Europe--what determines the implementation rate? EUROINTERVENTION 2014; 8 Suppl P:P18-26. [PMID: 22917786 DOI: 10.4244/eijv8spa5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Primary percutaneous coronary intervention (PPCI) is the recommended treatment for patients with acute ST-segment elevation myocardial infarction (STEMI). A survey conducted in 2008 in the European Society of Cardiology (ESC) countries reported that the annual incidence of hospital admissions for acute STEMI is around 800 patients per million inhabitants. The survey also showed that STEMI patients' access to reperfusion therapy and the use of PPCI or thrombolytic therapy (TT) vary considerably among countries. Northern, Western and Central Europe already had well-developed PPCI services, offering PPCI to 60-90% of all STEMI patients. Southern Europe and the Balkans were still predominantly using TT and had a higher proportion of patients who were left without any reperfusion treatment. The survey concluded that a nationwide PPCI strategy results in more patients being offered reperfusion therapy. To address the inequalities in STEMI patients' access to life-saving PPCI and to support the implementation of the ESC STEMI treatment guidelines in Europe, the Stent for Life (SFL) Initiative was launched jointly by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) and EuroPCR in 2008. The aim of the SFL Initiative is to improve the delivery of life-saving PPCI for STEMI patients. Currently, 10 national cardiac societies support the SFL Initiative in their respective countries. SFL national action programmes have been developed and are being implemented in several countries. The formation of regional PPCI networks involving emergency medical services, non-PPCI hospitals and PPCI centres is considered to be a critical factor in implementing PPCI services effectively. Better monitoring of STEMI incidence and prospective registration of PPCI in all countries is required to document improvements in health care and to identify areas where further effort is required. Furthermore, studies on potential factors or characteristics that explain the national penetration of PPCI are needed. Such knowledge will be necessary to increase the effectiveness and efficiency of the implementation, and will be the first step in ensuring equal access to PPCI treatment for STEMI patients in Europe. Establishing the delivery of PPCI in an effective, high-quality and timely manner is a great challenge.
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O'Connor RE, Nichol G, Gonzales L, Manoukian SV, Moyer PH, Rokos I, Sayre MR, Solomon RC, Wingrove GL, Brady WJ, McBride S, Lorden AL, Roettig ML, Acuna A, Jacobs AK. Emergency medical services management of ST-segment elevation myocardial infarction in the United States--a report from the American Heart Association Mission: Lifeline Program. Am J Emerg Med 2014; 32:856-63. [PMID: 24865499 DOI: 10.1016/j.ajem.2014.04.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 04/06/2014] [Accepted: 04/11/2014] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE ST-segment elevation myocardial infarction (STEMI) is a major cause of morbidity and mortality in the United States. Emergency medical services (EMS) agencies play a critical role in its initial identification and treatment. We conducted this study to assess EMS management of STEMI care in the United States. METHODS A structured questionnaire was administered to leaders of EMS agencies to define the elements of STEMI care related to 4 core measures: (1) electrocardiogram (ECG) capability at the scene, (2) destination protocols, (3) catheterization laboratory activation before hospital arrival, and (4) 12-lead ECG quality review. Geographic areas were grouped into large metropolitan, small metropolitan, micropolitan, and noncore (or rural) by using Urban Influence Codes, with a stratified analysis. RESULTS Data were included based on responses from 5296 EMS agencies (36% of those in the United States) serving 91% of the US population, with at least 1 valid response from each of the 50 states and the District of Columbia. Approximately 63% of agencies obtained ECGs at the scene using providers trained in ECG acquisition and interpretation. A total of 46% of EMS systems used protocols to determine hospital destination, cardiac catheterization laboratory activation, and communications with the receiving hospital. More than 75% of EMS systems used their own agency funds to purchase equipment, train personnel, and provide administrative oversight. A total of 49% of agencies have quality review programs in place. In general, EMS systems covering higher population densities had easier access to resources needed to maintain STEMI systems of care. Emergency medical services systems that have adopted all 4 core elements cover 14% of the US population. CONCLUSIONS There are large differences in EMS systems of STEMI care in the United States. Most EMS agencies have implemented at least 1 of the 4 core elements of STEMI care, with many having implemented multiple elements.
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Affiliation(s)
- Robert E O'Connor
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA.
| | - Graham Nichol
- University of Washington-Harborview Center for Prehospital Emergency Care, University of Washington, Seattle, WA
| | | | - Steven V Manoukian
- Clinical and Physician Services Group, Hospital Corporation of America, Nashville, TN
| | | | - Ivan Rokos
- Department of Emergency Medicine, Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Michael R Sayre
- Division of Emergency Medicine, Department of Medicine, University of Washington, Seattle, WA
| | | | | | - William J Brady
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | - Susan McBride
- School of Nursing, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Andrea L Lorden
- Department of Health Policy and Management, Texas A&M Health Science Center, College Station, TX
| | | | | | - Alice K Jacobs
- Department of Medicine, Boston University School of Medicine, Boston, MA
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MEHTA SAMEER, BOTELHO ROBERTO, RODRIGUEZ DANIEL, FERNÁNDEZ FRANCISCOJ, OSSA MARIAM, ZHANG TRACY, KOSTELA JENNIFERC, REYNBAKH OLGA, FALCÃO BRENO, VELÁSQUEZ ALICIAHENAO, OLIVEROS ESTEFANIA, PENA CAMILO. A Tale of Two Cities: STEMI Interventions in Developed and Developing Countries and the Potential of Telemedicine to Reduce Disparities in Care. J Interv Cardiol 2014; 27:155-66. [DOI: 10.1111/joic.12117] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- SAMEER MEHTA
- University of Miami; Miller School of Medicine; Miami Florida
- Lumen Foundation; Miami Florida
| | | | | | | | - MARIA M. OSSA
- University of Miami; Miller School of Medicine; Miami Florida
- Lumen Foundation; Miami Florida
| | - TRACY ZHANG
- University of Miami; Miller School of Medicine; Miami Florida
- Lumen Foundation; Miami Florida
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Shavelle DM, Chen AY, Matthews RV, Roe MT, de Lemos JA, Jollis J, Thomas JL, French WJ. Predictors of reperfusion delay in patients with ST elevation myocardial infarction self-transported to the hospital (from the American Heart Association's Mission: Lifeline Program). Am J Cardiol 2014; 113:798-802. [PMID: 24393257 DOI: 10.1016/j.amjcard.2013.11.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 11/18/2013] [Accepted: 11/18/2013] [Indexed: 11/19/2022]
Abstract
Primary percutaneous coronary intervention for ST elevation myocardial infarction (STEMI) is beneficial if performed in a timely manner. Self-transport patients with STEMI have prolonged treatment times compared with Emergency Medical Services-transported patients. This study evaluated self-transport patients with STEMI undergoing primary percutaneous coronary intervention to identify factors associated with prolonged door-to-balloon (D2B) times. From January 2007 to March 2011, data for 13,379 self-transport patients with STEMI treated at 432 hospitals in the Acute Coronary Treatment Intervention Outcomes Network Registry-Get With The Guidelines Registry were evaluated. Patients with a D2B time >90 minutes were compared with those with D2B time ≤90 minutes. Factors associated with prolonged D2B (>90 minutes) were explored using logistic generalized estimating equations. The median (twenty-fifth, seventy-fifth percentiles) D2B time for the entire cohort was 72 minutes (58, 86), and 19% had a D2B time of >90 minutes. Over the study period, there was a significant increase in the percentage of patients achieving D2B time ≤90 minutes. There were significant baseline differences between patients with D2B time ≤ versus >90 minutes. The main factors associated with prolonged treatment time were off-hour presentation (weekends and 7 p.m. to 7 a.m. weekdays), not obtaining an electrocardiogram within 10 minutes of hospital arrival, previous coronary artery bypass surgery, black race, older age, and female gender. In conclusion, although prolonged delay from arrival to electrocardiographic acquisition is a modifiable factor contributing to prolonged D2B times among self-transport patients with STEMI, additional factors (age, race, and gender) indicate that historic disparities for cardiovascular care still persist in terms of contemporary metrics for STEMI reperfusion.
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Affiliation(s)
- David M Shavelle
- Division of Cardiovascular Medicine, University of Southern California, Los Angeles, California.
| | - Anita Y Chen
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Ray V Matthews
- Division of Cardiovascular Medicine, University of Southern California, Los Angeles, California
| | - Matthew T Roe
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - James A de Lemos
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - James Jollis
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Joseph L Thomas
- Division of Cardiology, Harbor UCLA Medical Center, Torrance, California
| | - William J French
- Division of Cardiology, Harbor UCLA Medical Center, Torrance, California
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Abstract
INTRODUCTION The time interval from diagnosis to reperfusion therapy for patients experiencing ST-segment elevation myocardial infarction (STEMI) has a significant impact on morbidity and mortality. HYPOTHESIS It is hypothesized that the time required for interfacility patient transfers from a community hospital to a regional percutaneous coronary intervention (PCI) center using an Advanced Life Support (ALS) transfer ambulance service is no different than utilizing the "911" ALS ambulance. METHODS Quality assurance data collected by a tertiary care center cardiac catheterization program were reviewed retrospectively. Data were collected on all patients with STEMI requiring interfacility transfer from a local community hospital to the tertiary care center's PCI suite, approximately 16 miles away by ground, 12 miles by air. In 2009, transfers of patients with STEMI were redirected to the municipal ALS ambulance service, instead of the hospital's contracted ALS transfer service. Data were collected from January 2007 through May 2013. Temporal data were compared between transports initiated through the contracted ALS ambulance service and the municipal ALS service. Data points included time of initial transport request and time of ambulance arrival to the sending facility and the receiving PCI suite. RESULTS During the 4-year study period, 63 patients diagnosed with STEMI and transferred to the receiving hospital's PCI suite were included in this study. Mean times from the transport request to arrival of the ambulance at the sending hospital's emergency department were six minutes (95% CI, 4-7 minutes) via municipal ALS and 13 minutes (95% CI, 9-16 minutes) for the ALS transfer service. The mean times from the ground transport request to arrival at the receiving hospital's PCI suite when utilizing the municipal ALS ambulance and hospital contracted ALS ambulance services were 48 minutes (95% CI, 33-64 minutes) and 56 minutes (95% CI 52-59 minutes), respectively. This eight-minute period represented a 14% (P = .001) reduction in the mean transfer time to the PCI suite for patients transported via the municipal ALS ambulance. CONCLUSION In the appropriate setting, the use of the municipal "911" ALS ambulance service for the interfacility transport of patients with STEMI appears advantageous in reducing door-to-catheterization times.
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Langabeer JR, Dellifraine J, Fowler R, Jollis JG, Stuart L, Segrest W, Griffin R, Koenig W, Moyer P, Henry TD. Emergency medical services as a strategy for improving ST-elevation myocardial infarction system treatment times. J Emerg Med 2013; 46:355-62. [PMID: 24268897 DOI: 10.1016/j.jemermed.2013.08.112] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 04/22/2013] [Accepted: 08/15/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Reducing delays in time to treatment is a key goal of ST-elevation myocardial infarction (STEMI) emergency care. Emergency medical services (EMS) are a critical component of the STEMI chain of survival. STUDY OBJECTIVE We sought to assess the impact of the careful integration of EMS as a strategy for improving systemic treatment times for STEMI. METHODS We conducted a study of all 747 nontransfer STEMI patients who underwent primary percutaneous coronary intervention (PCI) in Dallas County, Texas from October 1, 2010 through December 31, 2011. EMS leaders from 24 agencies and 15 major PCI receiving hospitals collected and shared common, de-identified patient data. We used 15 months of data to develop a generalized linear regression to assess the impact of EMS on two treatment metrics-hospital door to balloon (D2B) time, and symptom onset to arterial reperfusion (SOAR) time, a new metric we developed to assess total treatment times. RESULTS We found statistically significant reductions in median D2B (11.1-min reduction) and SOAR (63.5-min reduction) treatment times when EMS transported patients to the receiving facility, compared to self-transport. In addition, when trained EMS paramedics field-activated the cardiac catheterization laboratory using predefined specified protocols, D2B times were reduced by 38% (43 min) after controlling for confounding variables, and field activation was associated with a 21.9% reduction (73 min) in the mean SOAR time (both with p < 0.001). CONCLUSION Active EMS engagement in STEMI treatment was associated with significantly lower D2B and total coronary reperfusion times.
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Affiliation(s)
| | | | - Raymond Fowler
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | | | | | - William Koenig
- Los Angeles County Emergency Medical Services, University of California Los Angeles School of Medicine, Los Angeles, California
| | - Peter Moyer
- Boston University School of Medicine, Boston, Massachusetts
| | - Timothy D Henry
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
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A guideline based approach of percutaneous coronary intervention in acute myocardial infarction: Single center experience. Egypt Heart J 2013. [DOI: 10.1016/j.ehj.2012.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Shavelle DM, Zheng L, Ottochian M, Wagman B, Testa N, Hall S, Koenig W, Chan LS, Matthews RV. Time of day variation in door-to-balloon time for STEMI patients in Los Angeles County: Does time of day make a difference? ACTA ACUST UNITED AC 2013; 15:52-7. [DOI: 10.3109/17482941.2013.776690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Enhancing the efficacy of delivering reperfusion therapy: a European and North American experience with ST-segment elevation myocardial infarction networks. Am Heart J 2013; 165:123-32. [PMID: 23351814 DOI: 10.1016/j.ahj.2012.10.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 10/26/2012] [Indexed: 11/20/2022]
Abstract
Advances in technique and adjunctive medication have improved outcome of ST-segment elevation myocardial infarction (STEMI) patients. However, the timely delivery and administration of reperfusion strategies to all eligible patients remain challenging. Currently, up to one-third of eligible STEMI patients in industrialized countries worldwide receive no specific reperfusion treatment, a problem that is rectified by the development and implementation of STEMI networks, as also recommended by the latest European Society of Cardiology and American College of Cardiology/American Heart Association guidelines. Indeed, over the last 5 years, published figures demonstrate that STEMI networks increase the percentage of patients treated by any reperfusion strategy, and the percentage of patients receiving treatment within the recommended time frames has also improved, thereby reducing in-hospital and long-term mortality to very low levels. This manuscript demonstrates how STEMI networks can be adapted to local needs and circumstances against pre-existing barriers and despite the heterogeneity in local situations, patient's characteristics, treatment delays, and distances for transfer. Modern and efficacious networks must be prepared to offer both primary percutaneous coronary intervention and thrombolytic therapy, preferably prehospital, as long as primary percutaneous coronary intervention cannot be guaranteed to all individuals within the recommended timeline.
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Solla DJF, de Mattos Paiva Filho I, Delisle JE, Braga AA, de Moura JB, de Moraes X, Filgueiras NM, Carvalho ME, Martins MS, Neto OM, Filho PR, de Souza Roriz P. Integrated Regional Networks for ST-Segment–Elevation Myocardial Infarction Care in Developing Countries. Circ Cardiovasc Qual Outcomes 2013; 6:9-17. [DOI: 10.1161/circoutcomes.112.967505] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Regionalized integrated networks for ST-segment–elevation myocardial infarction (STEMI) care have been proposed as a step forward in overcoming real-world obstacles, but data are lacking on its performance in developing countries. We describe an integrated regional STEMI network in Salvador, Bahia, Brazil.
Methods and Results—
The network was created in 2009. It was coordinated by the prehospital emergency medical service and encompassed the public emergency system (prehospital mobile units, community-based emergency units, general hospitals, and cardiology reference centers). The 12-lead ECGs are interpreted via telemedicine. This network operates as follows: The Telemedicine Center sends each ECG suggestive of STEMI to a Regional STEMI Alert Team, which, together with emergency medical services, offers support for thrombolysis or immediate transfer for primary percutaneous coronary intervention. In 14 months, there were 433 suspected victims, of which in 287 (76.5%) the STEMI could be confirmed (age, 62.1±12.5 years; 63.4% men). Most of them were self-transported. The median pain-to-admission time was 180 minutes (interquartile range, 90–473 minutes), and the median admission-to-ECG time was 159.5 minutes (interquartile range, 83.5–340 minutes). The median interval time between the ECG and the telemedicine report was 31 minutes (interquartile range, 21–44 minutes). For those who sought medical attention and had an ECG performed within 12 hours after symptoms onset (n=119), the reperfusion rate was 75.6% (34.4% by thrombolysis and 65.6% by primary percutaneous coronary intervention).
Conclusions—
Regional STEMI networks may be feasible in developing countries. Preliminary results showed this network to be effective, achieving primary reperfusion rtes comparable with those reported internationally despite the obstacles faced.
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Affiliation(s)
- Davi Jorge Fontoura Solla
- From the Federal University of Bahia (D.J.F.S.) and Service d’Aide Médicale Urgente (D.J.F.S., I.d.M.P.F., A.A.B., N.M.F., M.E.C., M.S.M., O.M.N., P.R.F., P.d.S.R.), Salvador, Bahia, Brazil; Telemedicina da Bahia, Salvador, Bahia, Brazil (J.E.D.); and Agamenon Magalhães Hospital, Recife, Pernambuco, Brazil (J.B.d.M.X.d.M.)
| | - Ivan de Mattos Paiva Filho
- From the Federal University of Bahia (D.J.F.S.) and Service d’Aide Médicale Urgente (D.J.F.S., I.d.M.P.F., A.A.B., N.M.F., M.E.C., M.S.M., O.M.N., P.R.F., P.d.S.R.), Salvador, Bahia, Brazil; Telemedicina da Bahia, Salvador, Bahia, Brazil (J.E.D.); and Agamenon Magalhães Hospital, Recife, Pernambuco, Brazil (J.B.d.M.X.d.M.)
| | - Jacques Edouard Delisle
- From the Federal University of Bahia (D.J.F.S.) and Service d’Aide Médicale Urgente (D.J.F.S., I.d.M.P.F., A.A.B., N.M.F., M.E.C., M.S.M., O.M.N., P.R.F., P.d.S.R.), Salvador, Bahia, Brazil; Telemedicina da Bahia, Salvador, Bahia, Brazil (J.E.D.); and Agamenon Magalhães Hospital, Recife, Pernambuco, Brazil (J.B.d.M.X.d.M.)
| | - Alecianne Azevedo Braga
- From the Federal University of Bahia (D.J.F.S.) and Service d’Aide Médicale Urgente (D.J.F.S., I.d.M.P.F., A.A.B., N.M.F., M.E.C., M.S.M., O.M.N., P.R.F., P.d.S.R.), Salvador, Bahia, Brazil; Telemedicina da Bahia, Salvador, Bahia, Brazil (J.E.D.); and Agamenon Magalhães Hospital, Recife, Pernambuco, Brazil (J.B.d.M.X.d.M.)
| | - João Batista de Moura
- From the Federal University of Bahia (D.J.F.S.) and Service d’Aide Médicale Urgente (D.J.F.S., I.d.M.P.F., A.A.B., N.M.F., M.E.C., M.S.M., O.M.N., P.R.F., P.d.S.R.), Salvador, Bahia, Brazil; Telemedicina da Bahia, Salvador, Bahia, Brazil (J.E.D.); and Agamenon Magalhães Hospital, Recife, Pernambuco, Brazil (J.B.d.M.X.d.M.)
| | - Xavier de Moraes
- From the Federal University of Bahia (D.J.F.S.) and Service d’Aide Médicale Urgente (D.J.F.S., I.d.M.P.F., A.A.B., N.M.F., M.E.C., M.S.M., O.M.N., P.R.F., P.d.S.R.), Salvador, Bahia, Brazil; Telemedicina da Bahia, Salvador, Bahia, Brazil (J.E.D.); and Agamenon Magalhães Hospital, Recife, Pernambuco, Brazil (J.B.d.M.X.d.M.)
| | - Nivaldo Menezes Filgueiras
- From the Federal University of Bahia (D.J.F.S.) and Service d’Aide Médicale Urgente (D.J.F.S., I.d.M.P.F., A.A.B., N.M.F., M.E.C., M.S.M., O.M.N., P.R.F., P.d.S.R.), Salvador, Bahia, Brazil; Telemedicina da Bahia, Salvador, Bahia, Brazil (J.E.D.); and Agamenon Magalhães Hospital, Recife, Pernambuco, Brazil (J.B.d.M.X.d.M.)
| | - Marcela Embiruçu Carvalho
- From the Federal University of Bahia (D.J.F.S.) and Service d’Aide Médicale Urgente (D.J.F.S., I.d.M.P.F., A.A.B., N.M.F., M.E.C., M.S.M., O.M.N., P.R.F., P.d.S.R.), Salvador, Bahia, Brazil; Telemedicina da Bahia, Salvador, Bahia, Brazil (J.E.D.); and Agamenon Magalhães Hospital, Recife, Pernambuco, Brazil (J.B.d.M.X.d.M.)
| | - Mariana Steque Martins
- From the Federal University of Bahia (D.J.F.S.) and Service d’Aide Médicale Urgente (D.J.F.S., I.d.M.P.F., A.A.B., N.M.F., M.E.C., M.S.M., O.M.N., P.R.F., P.d.S.R.), Salvador, Bahia, Brazil; Telemedicina da Bahia, Salvador, Bahia, Brazil (J.E.D.); and Agamenon Magalhães Hospital, Recife, Pernambuco, Brazil (J.B.d.M.X.d.M.)
| | - Orlando Manganotti Neto
- From the Federal University of Bahia (D.J.F.S.) and Service d’Aide Médicale Urgente (D.J.F.S., I.d.M.P.F., A.A.B., N.M.F., M.E.C., M.S.M., O.M.N., P.R.F., P.d.S.R.), Salvador, Bahia, Brazil; Telemedicina da Bahia, Salvador, Bahia, Brazil (J.E.D.); and Agamenon Magalhães Hospital, Recife, Pernambuco, Brazil (J.B.d.M.X.d.M.)
| | - Paulo Roberto Filho
- From the Federal University of Bahia (D.J.F.S.) and Service d’Aide Médicale Urgente (D.J.F.S., I.d.M.P.F., A.A.B., N.M.F., M.E.C., M.S.M., O.M.N., P.R.F., P.d.S.R.), Salvador, Bahia, Brazil; Telemedicina da Bahia, Salvador, Bahia, Brazil (J.E.D.); and Agamenon Magalhães Hospital, Recife, Pernambuco, Brazil (J.B.d.M.X.d.M.)
| | - Pollianna de Souza Roriz
- From the Federal University of Bahia (D.J.F.S.) and Service d’Aide Médicale Urgente (D.J.F.S., I.d.M.P.F., A.A.B., N.M.F., M.E.C., M.S.M., O.M.N., P.R.F., P.d.S.R.), Salvador, Bahia, Brazil; Telemedicina da Bahia, Salvador, Bahia, Brazil (J.E.D.); and Agamenon Magalhães Hospital, Recife, Pernambuco, Brazil (J.B.d.M.X.d.M.)
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O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX, Anderson JL, Jacobs AK, Halperin JL, Albert NM, Brindis RG, Creager MA, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Kushner FG, Ohman EM, Stevenson WG, Yancy CW. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2012; 127:e362-425. [PMID: 23247304 DOI: 10.1161/cir.0b013e3182742cf6] [Citation(s) in RCA: 1071] [Impact Index Per Article: 89.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2012; 61:e78-e140. [PMID: 23256914 DOI: 10.1016/j.jacc.2012.11.019] [Citation(s) in RCA: 2191] [Impact Index Per Article: 182.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Sen S, Davies JE, Malik IS, Foale RA, Mikhail GW, Hadjiloizou N, Hughes A, Mayet J, Francis DP. Why Does Primary Angioplasty Not Work in Registries? Quantifying the Susceptibility of Real-World Comparative Effectiveness Data to Allocation Bias. Circ Cardiovasc Qual Outcomes 2012; 5:759-66. [DOI: 10.1161/circoutcomes.112.966853] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background—
Meta-analysis of registries (comparative effectiveness research) shows that primary angioplasty and fibrinolysis have equivalent real-world survival. Yet, randomized, controlled trials consistently find primary angioplasty superior. Can unequal allocation of higher-risk patients in registries have masked primary angioplasty benefit?
Methods and Results—
First, we constructed a model to demonstrate the potential effect of allocation bias. We then analyzed published registries (55022 patients) for allocation of higher-risk patients (Killip class ≥1) to determine whether the choice of reperfusion therapy was affected by the risk level of the patient. Meta-regression was used to examine the relationship between differences in allocation of high-risk patient to primary angioplasty or fibrinolysis and mortality. Initial modeling suggested that registry outcomes are sensitive to allocation bias of high-risk patients. Across the registries, the therapy receiving excess high-risk patients had worse mortality. Unequal distribution of high-risk status accounted for most of the between-registry variance (adjusted
R
2
meta
=83.1%). Accounting for differential allocation of higher-risk patients, primary angioplasty gave 22% lower mortality (odds ratio, 0.78; 95% confidence interval, 0.64–0.97;
P
=0.029). We derive a formula, called the number needed to abolish, highlighting situations in which comparative effectiveness studies are particularly vulnerable to this bias.
Conclusions—
In ST-segment elevation myocardial infarction, clinicians’ preference for management of a few high-risk patients can shift mortality substantially. Comparative effectiveness research in any disease is vulnerable to this, especially diseases with an immediately identifiable high-risk subgroup that clinicians prefer to allocate to 1 therapy. For this reason, preliminary indications from registry-based comparative effectiveness research should be definitively tested by randomized, controlled trials.
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Affiliation(s)
- Sayan Sen
- From the Imperial College Healthcare National Health Service Trust, St. Mary’s Hospital, Imperial College London, London, UK
| | - Justin E. Davies
- From the Imperial College Healthcare National Health Service Trust, St. Mary’s Hospital, Imperial College London, London, UK
| | - Iqbal S. Malik
- From the Imperial College Healthcare National Health Service Trust, St. Mary’s Hospital, Imperial College London, London, UK
| | - Rodney A. Foale
- From the Imperial College Healthcare National Health Service Trust, St. Mary’s Hospital, Imperial College London, London, UK
| | - Ghada W. Mikhail
- From the Imperial College Healthcare National Health Service Trust, St. Mary’s Hospital, Imperial College London, London, UK
| | - Nearchos Hadjiloizou
- From the Imperial College Healthcare National Health Service Trust, St. Mary’s Hospital, Imperial College London, London, UK
| | - Alun Hughes
- From the Imperial College Healthcare National Health Service Trust, St. Mary’s Hospital, Imperial College London, London, UK
| | - Jamil Mayet
- From the Imperial College Healthcare National Health Service Trust, St. Mary’s Hospital, Imperial College London, London, UK
| | - Darrel P. Francis
- From the Imperial College Healthcare National Health Service Trust, St. Mary’s Hospital, Imperial College London, London, UK
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Rodríguez-Vilá O, Campos-Esteve MA. Setting Up a Population-Based Program to Optimize ST-Segment Elevation Myocardial Infarction Care. Interv Cardiol Clin 2012; 1:583-597. [PMID: 28581971 DOI: 10.1016/j.iccl.2012.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The development of ST-segment elevation myocardial infarction (STEMI) systems of care at the city, region, or nation levels has not only improved the speed of reperfusion but also enhanced the reach of primary angioplasty to areas far from percutaneous coronary intervention (PCI) centers. Setting up a STEMI system of care is a sophisticated process that requires a solid PCI hospital and emergency medical services infrastructure, disciplined collaboration, and a focus on outcomes measurement and continuous quality improvement. This article reviews the accumulated evidence supporting the development of STEMI systems of care and offers practical insights into this process.
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Affiliation(s)
- Orlando Rodríguez-Vilá
- Cardiac Catheterization Laboratories, Cardiology Section, VA Caribbean Healthcare System, 10 Casia Street, San Juan 00921, Puerto Rico; Cardiac Catheterization Laboratories, Auxilio Mutuo Hospital, 735 Ponce de Leon, Suite 503, Torre Medical Auxilio Mutuo, Hato Rey 00917, Puerto Rico.
| | - Miguel A Campos-Esteve
- Cardiac Catheterization Laboratories, Pavia Hospital, 1462 Asia Street, Santurce 00909, Puerto Rico
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Regionalization of post-cardiac arrest care: implementation of a cardiac resuscitation center. Am Heart J 2012; 164:493-501.e2. [PMID: 23067906 DOI: 10.1016/j.ahj.2012.06.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 06/22/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND Guidelines recommend standardized treatment of post-cardiac arrest patients to improve outcomes. However, the infrastructure, resources, and personnel required to meet the complex needs of cardiac arrest victims remain a barrier to care. Given that regionalization of time-dependent high-acuity illness is an emerging paradigm, the aim of the present study was to develop and implement a regionalized approach to post-cardiac arrest care. METHODS We performed a prospective observational study on all patients treated in a regionalized clinical pathway from November 2007 through June 2011. All patients were enrolled after admission to an urban academic medical center. Clinical data including arrest and treatment variables, complications, and outcome were collected on consecutive patients with the use of a preformatted standard data collection tool using Utstein criteria. RESULTS A total of 220 patients were enrolled; 127 (58%) patients were local direct admissions from our community, and 93 (42%) were transferred from 1 of 24 outlying referral hospitals. One hundred six (48%, 95% CI 38%-53%) patients survived to hospital discharge. The primary outcome of hospital survival with good neurologic function was observed in 94 (43%, 95% CI 32%-48%). There was no difference in survival with good neurologic outcome among local and referred patients. Overall 1-year survival was 44% (95% CI 38%-51%). Among patients discharged from the hospital with good neurologic function, 93% (95% CI 85%-97%) remained alive at 1 year. CONCLUSION Development of a regionalized approach to post-cardiac arrest care using previously established referral relationships is feasible, and implementation of such an approach was clinically effective in our region.
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43
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Sobhy M, Sadaka M, Okasha N, Farag ES, Saleh A, Ismail H, El Seteiha M, Ragy H, Hameed MA, Mehanna R. Stent for Life Initiative placed at the forefront in Egypt 2011. EUROINTERVENTION 2012; 8 Suppl P:P108-15. [PMID: 22917780 DOI: 10.4244/eijv8spa19] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Mohamed Sobhy
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
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44
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Jollis JG, Granger CB, Henry TD, Antman EM, Berger PB, Moyer PH, Pratt FD, Rokos IC, Acuña AR, Roettig ML, Jacobs AK. Systems of Care for ST-Segment–Elevation Myocardial Infarction: A Report From the American Heart Association’s
Mission: Lifeline. Circ Cardiovasc Qual Outcomes 2012; 5:423-8. [DOI: 10.1161/circoutcomes.111.964668] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background—
National guidelines call for participation in systems to rapidly diagnose and treat ST-segment–elevation myocardial infarction (STEMI). In order to characterize currently implemented STEMI reperfusion systems and identify practices common to system organization, the American Heart Association surveyed existing systems throughout the United States.
Methods and Results—
A STEMI system was defined as an integrated group of separate entities focused on reperfusion therapy for STEMI within a geographic region that included at least 1 hospital that performs percutaneous coronary intervention and at least 1 emergency medical service agency. Systems meeting this definition were invited to participate in a survey of 42 questions based on expert panel opinion and knowledge of existing systems. Data were collected through the American Heart Association
Mission: Lifeline
website.
Between April 2008 and January 2010, 381 unique systems involving 899 percutaneous coronary intervention hospitals in 47 states responded to the survey, of which 255 systems (67%) involved urban regions. The predominant funding sources for STEMI systems were percutaneous coronary intervention hospitals (n = 320, 84%) and /or cardiology practices (n = 88, 23%). Predominant system characteristics identified by the survey included: STEMI patient acceptance at percutaneous coronary intervention hospital regardless of bed availability (N = 346, 97%); single phone call activation of catheterization laboratory (N = 335, 92%); emergency department physician activation of laboratory without cardiology consultation (N = 318, 87%); data registry participation (N = 311, 84%); and prehospital activation of the laboratory through emergency department notification without cardiology notification (N = 297, 78%). The most common barriers to system implementation were hospital (n = 139, 37%) and cardiology group competition (n = 81, 21%) and emergency medical services transport and finances (n = 99, 26%).
Conclusions—
This survey broadly describes the organizational characteristics of collaborative efforts by hospitals and emergency medical services to provide timely reperfusion in the United States. These findings serve as a benchmark for existing systems and should help guide healthcare teams in the process of organizing care for patients with STEMI.
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Affiliation(s)
- James G. Jollis
- From Duke University Medical Center, Durham, NC (J.G.J., C.B.G.); Minneapolis Heart Institute Foundation, Minneapolis, MN (T.D.H.); Brigham and Women’s Hospital, Boston, MA (E.M.A.); Geisinger Health System, Danville, PA (P.B.B.); Boston Emergency Medical Services, Boston, MA (P.H.M.); Los Angeles County Fire Department, Los Angeles, CA (F.D.P.); University of California, Los Angeles (UCLA)-Olive View Medical Center, David Geffen School of Medicine at UCLA (I.C.R.); American Heart Association,
| | - Christopher B. Granger
- From Duke University Medical Center, Durham, NC (J.G.J., C.B.G.); Minneapolis Heart Institute Foundation, Minneapolis, MN (T.D.H.); Brigham and Women’s Hospital, Boston, MA (E.M.A.); Geisinger Health System, Danville, PA (P.B.B.); Boston Emergency Medical Services, Boston, MA (P.H.M.); Los Angeles County Fire Department, Los Angeles, CA (F.D.P.); University of California, Los Angeles (UCLA)-Olive View Medical Center, David Geffen School of Medicine at UCLA (I.C.R.); American Heart Association,
| | - Timothy D. Henry
- From Duke University Medical Center, Durham, NC (J.G.J., C.B.G.); Minneapolis Heart Institute Foundation, Minneapolis, MN (T.D.H.); Brigham and Women’s Hospital, Boston, MA (E.M.A.); Geisinger Health System, Danville, PA (P.B.B.); Boston Emergency Medical Services, Boston, MA (P.H.M.); Los Angeles County Fire Department, Los Angeles, CA (F.D.P.); University of California, Los Angeles (UCLA)-Olive View Medical Center, David Geffen School of Medicine at UCLA (I.C.R.); American Heart Association,
| | - Elliott M. Antman
- From Duke University Medical Center, Durham, NC (J.G.J., C.B.G.); Minneapolis Heart Institute Foundation, Minneapolis, MN (T.D.H.); Brigham and Women’s Hospital, Boston, MA (E.M.A.); Geisinger Health System, Danville, PA (P.B.B.); Boston Emergency Medical Services, Boston, MA (P.H.M.); Los Angeles County Fire Department, Los Angeles, CA (F.D.P.); University of California, Los Angeles (UCLA)-Olive View Medical Center, David Geffen School of Medicine at UCLA (I.C.R.); American Heart Association,
| | - Peter B. Berger
- From Duke University Medical Center, Durham, NC (J.G.J., C.B.G.); Minneapolis Heart Institute Foundation, Minneapolis, MN (T.D.H.); Brigham and Women’s Hospital, Boston, MA (E.M.A.); Geisinger Health System, Danville, PA (P.B.B.); Boston Emergency Medical Services, Boston, MA (P.H.M.); Los Angeles County Fire Department, Los Angeles, CA (F.D.P.); University of California, Los Angeles (UCLA)-Olive View Medical Center, David Geffen School of Medicine at UCLA (I.C.R.); American Heart Association,
| | - Peter H. Moyer
- From Duke University Medical Center, Durham, NC (J.G.J., C.B.G.); Minneapolis Heart Institute Foundation, Minneapolis, MN (T.D.H.); Brigham and Women’s Hospital, Boston, MA (E.M.A.); Geisinger Health System, Danville, PA (P.B.B.); Boston Emergency Medical Services, Boston, MA (P.H.M.); Los Angeles County Fire Department, Los Angeles, CA (F.D.P.); University of California, Los Angeles (UCLA)-Olive View Medical Center, David Geffen School of Medicine at UCLA (I.C.R.); American Heart Association,
| | - Franklin D. Pratt
- From Duke University Medical Center, Durham, NC (J.G.J., C.B.G.); Minneapolis Heart Institute Foundation, Minneapolis, MN (T.D.H.); Brigham and Women’s Hospital, Boston, MA (E.M.A.); Geisinger Health System, Danville, PA (P.B.B.); Boston Emergency Medical Services, Boston, MA (P.H.M.); Los Angeles County Fire Department, Los Angeles, CA (F.D.P.); University of California, Los Angeles (UCLA)-Olive View Medical Center, David Geffen School of Medicine at UCLA (I.C.R.); American Heart Association,
| | - Ivan C. Rokos
- From Duke University Medical Center, Durham, NC (J.G.J., C.B.G.); Minneapolis Heart Institute Foundation, Minneapolis, MN (T.D.H.); Brigham and Women’s Hospital, Boston, MA (E.M.A.); Geisinger Health System, Danville, PA (P.B.B.); Boston Emergency Medical Services, Boston, MA (P.H.M.); Los Angeles County Fire Department, Los Angeles, CA (F.D.P.); University of California, Los Angeles (UCLA)-Olive View Medical Center, David Geffen School of Medicine at UCLA (I.C.R.); American Heart Association,
| | - Anna R. Acuña
- From Duke University Medical Center, Durham, NC (J.G.J., C.B.G.); Minneapolis Heart Institute Foundation, Minneapolis, MN (T.D.H.); Brigham and Women’s Hospital, Boston, MA (E.M.A.); Geisinger Health System, Danville, PA (P.B.B.); Boston Emergency Medical Services, Boston, MA (P.H.M.); Los Angeles County Fire Department, Los Angeles, CA (F.D.P.); University of California, Los Angeles (UCLA)-Olive View Medical Center, David Geffen School of Medicine at UCLA (I.C.R.); American Heart Association,
| | - Mayme Lou Roettig
- From Duke University Medical Center, Durham, NC (J.G.J., C.B.G.); Minneapolis Heart Institute Foundation, Minneapolis, MN (T.D.H.); Brigham and Women’s Hospital, Boston, MA (E.M.A.); Geisinger Health System, Danville, PA (P.B.B.); Boston Emergency Medical Services, Boston, MA (P.H.M.); Los Angeles County Fire Department, Los Angeles, CA (F.D.P.); University of California, Los Angeles (UCLA)-Olive View Medical Center, David Geffen School of Medicine at UCLA (I.C.R.); American Heart Association,
| | - Alice K. Jacobs
- From Duke University Medical Center, Durham, NC (J.G.J., C.B.G.); Minneapolis Heart Institute Foundation, Minneapolis, MN (T.D.H.); Brigham and Women’s Hospital, Boston, MA (E.M.A.); Geisinger Health System, Danville, PA (P.B.B.); Boston Emergency Medical Services, Boston, MA (P.H.M.); Los Angeles County Fire Department, Los Angeles, CA (F.D.P.); University of California, Los Angeles (UCLA)-Olive View Medical Center, David Geffen School of Medicine at UCLA (I.C.R.); American Heart Association,
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45
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Barge-Caballero E, Vázquez-Rodríguez JM, Estévez-Loureiro R, Calviño-Santos R, Salgado-Fernández J, Aldama-López G, Piñón-Esteban P, Flores-Ríos X, Campo-Pérez R, Rodríguez-Fernández JÁ, Lombán-Villanueva JA, Mesías-Prego A, Gutiérrez-Cortés JM, González-Juanatey C, Portela C, Iglesias-Vázquez A, Varela-Portas Mariño J, Vázquez-González N, Castro-Beiras A. Angioplastia primaria en el Área Norte de Galicia: cambios asistenciales y resultados tras la implantación del programa PROGALIAM. Rev Esp Cardiol 2012; 65:341-9. [DOI: 10.1016/j.recesp.2011.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 11/07/2011] [Indexed: 10/14/2022]
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Affiliation(s)
- Ivan C Rokos
- UCLA-Olive View Medical Center, Geffen School of Medicine, University of California at Los Angeles, 14445 Olive View Dr., Sylmar, CA 91342-1495, USA.
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47
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McMullan JT, Hinckley W, Bentley J, Davis T, Fermann GJ, Gunderman M, Hart KW, Knight WA, Lindsell CJ, Miller C, Shackleford A, Gibler WB. Ground emergency medical services requests for helicopter transfer of ST-segment elevation myocardial infarction patients decrease medical contact to balloon times in rural and suburban settings. Acad Emerg Med 2012; 19:153-60. [PMID: 22320366 DOI: 10.1111/j.1553-2712.2011.01273.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES ST-segment elevation myocardial infarction (STEMI) care is time-dependent. Many STEMI patients require interhospital helicopter transfer for percutaneous coronary intervention (PCI) if ground emergency medical services (EMS) initially transport the patient to a non-PCI center. This investigation models potential time savings of ground EMS requests for helicopter EMS (HEMS) transport of a STEMI patient directly to a PCI center, rather than usual transport to a local hospital with subsequent transfer. METHODS Data from a multicenter retrospective chart review of STEMI patients transferred for primary PCI by a single HEMS agency over 12 months were used to model medical contact to balloon times (MCTB) for two scenarios: a direct-to-scene HEMS response and hospital rendezvous after ground EMS initiation of transfer. RESULTS Actual MCTB median time for 36 hospital-initiated transfers was 160 minutes (range = 116 to 321 minutes). Scene response MCTB median time was estimated as 112 minutes (range = 69 to 187 minutes). The difference in medians was 48 minutes (95% confidence interval [CI] = 33 to 62 minutes). Hospital rendezvous MCTB median time was estimated as 113 minutes (range = 74 to 187 minutes). The difference in medians was 47 minutes (95% CI = 32 to 62 minutes). No patient had an actual MCTB time of less than 90 minutes; in the scene response and hospital rendezvous scenarios, 2 of 36 (6%) and 3 of 36 (8%), respectively, would have had MCTB times under 90 minutes. CONCLUSIONS In this setting, ground EMS initiation of HEMS transfers for STEMI patients has the potential to reduce MCTB time, but most patients will still not achieve MCTB time of less than 90 minutes.
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Affiliation(s)
- Jason T McMullan
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA
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48
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Tubaro M, Danchin N, Goldstein P, Filippatos G, Hasin Y, Heras M, Jansky P, Norekval TM, Swahn E, Thygesen K, Vrints C, Zahger D, Arntz HR, Bellou A, De La Coussaye JE, De Luca L, Huber K, Lambert Y, Lettino M, Lindahl B, Mclean S, Nibbe L, Peacock WF, Price S, Quinn T, Spaulding C, Tatu-Chitoiu G, Van De Werf F. Tratamiento prehospitalario de los pacientes con IAMCEST. Una declaración científica del Working Group Acute Cardiac Care de la European Society of Cardiology. Rev Esp Cardiol 2012. [DOI: 10.1016/j.recesp.2011.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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49
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The impact of prehospital activation of the cardiac catheterization team on time to treatment for patients presenting with ST-segment-elevation myocardial infarction. Am J Emerg Med 2011; 29:1117-24. [DOI: 10.1016/j.ajem.2010.08.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 08/10/2010] [Accepted: 08/11/2010] [Indexed: 11/21/2022] Open
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50
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Tran V, Huang HD, Diez JG, Kalife G, Goswami R, Paniagua D, Jneid H, Wilson JM, Sherron SR, Birnbaum Y. Differentiating ST-elevation myocardial infarction from nonischemic ST-elevation in patients with chest pain. Am J Cardiol 2011; 108:1096-101. [PMID: 21791329 DOI: 10.1016/j.amjcard.2011.06.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 06/06/2011] [Accepted: 06/06/2011] [Indexed: 01/09/2023]
Abstract
Current guidelines state that patients with compatible symptoms and ST-segment elevation (STE) in ≥2 contiguous electrocardiographic leads should undergo immediate reperfusion therapy. Aggressive attempts at decreasing door-to-balloon times have led to more frequent activation of primary percutaneous coronary intervention (pPCI) protocols. However, it remains crucial to correctly differentiate STE myocardial infarction (STEMI) from nonischemic STE (NISTE). We assessed the ability of experienced interventional cardiologists in determining whether STE represents acute STEMI or NISTE. Seven readers studied electrocardiograms of consecutive patients showing STE. Patients with left bundle branch block or ventricular rhythms were excluded. Readers decided if, based on electrocardiographic results, they would have activated the pPCI protocol. If NISTE was chosen, readers selected from 12 possible explanations as to why STE was present. Of 84 patients, 40 (48%) had adjudicated STEMI. The percentage for which readers recommended pPCI varied (33% to 75%). Readers' sensitivity and specificity ranged from 55% to 83% (average 71%) and 32% to 86% (average 63%), respectively. Positive and negative predictive values ranged from 52% to 79% (average 66%) and 67% to 79% (average 71%), respectively. Broad inconsistencies existed among readers as to the chosen reasons for NISTE classification. In conclusion, we found wide variations in experienced interventional cardiologists in differentiating STEMI with a need for pPCI from NISTE.
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Affiliation(s)
- Viet Tran
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA
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