Outcomes of a Provincial Myocardial Infarction Reperfusion Strategy: A Population-Based, Retrospective Cohort Study
Jolene Cook1,2,3,4, Alix Carter1,2,3,4, Judah Goldstein1,3
1Emergency Health Services, Halifax, Nova Scotia, Canada.
Insights
Prehospital fibrinolysis is a feasible treatment for ST-segment elevation myocardial infarction (STEMI). This approach showed no significant difference in 30-day mortality compared to other reperfusion strategies.
Area of Science:
- Cardiology
- Emergency Medicine
- Public Health
Background:
- Fibrinolysis is an alternative treatment for ST-segment elevation myocardial infarction (STEMI) when primary percutaneous coronary intervention (PCI) is delayed.
- Emergency Medical Services (EMS) interventions like prehospital fibrinolysis (PHF) and hospital bypass are recommended.
- Nova Scotia implemented a unique province-wide STEMI care approach incorporating these EMS interventions.
Purpose of the Study:
- To compare the 30-day mortality outcomes of patients receiving prehospital fibrinolysis (PHF) or emergency department fibrinolysis (EDF) versus direct transport for primary PCI.
- To evaluate the feasibility of a province-wide STEMI care strategy involving prehospital interventions.
Main Methods:
- Retrospective, population-based cohort study of STEMI patients in Nova Scotia (July 2011-July 2013).
- Data collected from provincial databases on demographics, 30-day mortality, readmission, and rescue PCI.
- Comparison of outcomes across four reperfusion strategies: PHF, EDF, EMS to PCI, and ED to PCI.
Main Results:
- 1,071 STEMI patients were analyzed across the four groups.
- No significant differences in 30-day mortality were observed among PHF (3%), EDF (6%), EMS to PCI (<2%), and ED to PCI (4%) groups (P = .28).
- No significant difference in rescue PCI rates for patients receiving fibrinolysis.
Conclusions:
- Prehospital fibrinolysis integrated into a province-wide STEMI care program is feasible.
- The study found no observed difference in 30-day patient mortality with the incorporation of PHF.
- This approach supports the effective delivery of STEMI care through early intervention.
Background:
Fibrinolysis is an acceptable treatment for acute ST-segment elevation myocardial infarction (STEMI) when primary percutaneous coronary intervention (PCI) cannot be performed within 120 minutes. The American Heart Association has recommended Emergency Medical Services (EMS) interventions such as prehospital fibrinolysis (PHF), prehospital electrocardiogram (ECG), and hospital bypass direct to PCI center. Nova Scotia, Canada has incorporated these interventions into a unique province-wide approach to STEMI care. A retrospective cohort analysis comparing the primary outcome of 30-day mortality for patients receiving either prehospital or emergency department (ED) fibrinolysis (EDF) to patients transported directly by EMS from community or regional ED for primary PCI was conducted.
Methods:
This retrospective, population-based cohort study included all STEMI patients in Nova Scotia who survived to hospital admission from July 2011 through July 2013. Three provincial databases were used to collect demographic, 30-day mortality, hospital readmission, and rescue PCI data. The results were grouped and compared according to reperfusion strategy received: PHF, EDF, patients brought by ambulance via EMS direct to PCI (EMS to PCI), and ED to PCI (ED to PCI).
Results:
There were 1,071 STEMI patients included with 145 PHF, 606 EDF, 98 EMS to PCI, and 222 ED to PCI. There were no significant differences in 30-day mortality across groups (n, %): PHF 5(3); EDF 36(6); EHS to PCI <5(2); and ED to PCI 10(4); P = .28. There was no significant difference in patients receiving fibrinolysis who underwent rescue PCI.
Conclusions:
Prehospital fibrinolysis incorporated into a province-wide approach to STEMI treatment is feasible with no observed difference in patient 30-day mortality outcomes observed.
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