Association between prehospital time intervals and ST-elevation myocardial infarction system performance
Jonathan R Studnek1, Lee Garvey, Tom Blackwell
1Carolinas Medical Center, Center for Prehospital Medicine, Charlotte, NC 28232, USA. jonst@medic911.com
Circulation
|September 30, 2010
Summary
Optimizing prehospital care for ST-elevation myocardial infarction (STEMI) is crucial. Key prehospital time intervals, especially scene departure to cardiac catheterization laboratory table time, significantly impact achieving the recommended 90-minute goal for percutaneous coronary intervention.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Systems Research
Background:
- Current guidelines recommend percutaneous coronary intervention (PCI) within 90 minutes for ST-segment-elevation myocardial infarction (STEMI).
- Prehospital time intervals are critical for STEMI system performance.
Purpose of the Study:
- To assess the association between prehospital time intervals and STEMI system performance.
- To identify key time intervals influencing the achievement of the 90-minute PCI goal.
Main Methods:
- Analysis of prehospital ECG data from STEMI patients between May 2007 and March 2009.
- Evaluation of specific time intervals: 9-1-1 call to ambulance arrival, ambulance to ECG, on-scene time, ECG to STEMI team notification, and scene departure to catheterization lab table.
- Logistic regression to determine the influence of time intervals on achieving PCI within 90 minutes.
Main Results:
- 165 of 181 STEMI patients had complete data.
- Scene departure to catheterization lab table time (≤30 minutes) was strongly associated with achieving PCI within 90 minutes (OR 11.1).
- Response time and on-scene time also significantly influenced system performance.
Conclusions:
- Prehospital timing benchmarks are associated with STEMI system performance.
- Focusing on scene departure to table time and on-scene time can improve PCI delivery within the recommended 90 minutes.
- This model helps identify areas for system improvement with the greatest clinical impact.
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