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Published on: May 28, 2019
Prehospital Activation of the Cardiac Catheterization Laboratory in ST-Segment-Elevation Myocardial Infarction for
Michael L Savage1,2, Karen Hay2,3, William Vollbon4
1Cardiology Department The Prince Charles Hospital Brisbane Queensland Australia.
Insights
Prehospital activation of the cardiac catheterization lab significantly improves ST-segment-elevation myocardial infarction (STEMI) care by reducing treatment times and lowering mortality. This crucial step in STEMI management enhances patient outcomes and survival rates.
Area of Science:
- Cardiology
- Emergency Medicine
- Public Health
Background:
- Prehospital activation of cardiac catheterization laboratories improves ST-segment-elevation myocardial infarction (STEMI) performance measures.
- Data on the impact of prehospital activation on mortality in STEMI patients, particularly in Australia, remain equivocal.
- The Queensland Cardiac Outcomes Registry (QCOR) provides a valuable dataset for evaluating these effects.
Purpose of the Study:
- To assess the association of prehospital activation with STEMI performance measures and cardiovascular mortality in patients undergoing primary percutaneous coronary intervention (PCI).
- To analyze data from the Queensland Cardiac Outcomes Registry (QCOR) for patients treated between January 1, 2017, and December 31, 2020.
Main Methods:
- Analysis of consecutive ambulance-transported STEMI patients treated with primary PCI from the QCOR database.
- Logistic regression analyses were used to estimate the total and direct effects of prehospital activation on 30-day and 1-year cardiovascular mortality.
- STEMI performance measures, including door-to-balloon and electrocardiograph-to-balloon times, were secondary outcomes.
Main Results:
- Of 2498 patients, 73% underwent prehospital activation, showing significantly shorter median door-to-balloon (34 vs. 86 minutes) and electrocardiograph-to-balloon times (83.5 vs. 109 minutes).
- Prehospital activation was associated with a higher proportion of patients meeting STEMI performance targets (e.g., door-to-balloon <60 minutes: 90% vs. 16%).
- Significantly lower 30-day (1.6% vs. 6.6%) and 1-year cardiovascular mortality (2.9% vs. 9.5%) were observed with prehospital activation. Adjusted analysis showed no prehospital activation was associated with increased mortality (30-day OR 3.6; 1-year OR 3.0).
Conclusions:
- Prehospital activation of the cardiac catheterization laboratory for primary PCI in STEMI patients significantly reduces time to reperfusion.
- This strategy leads to improved achievement of critical STEMI performance measures.
- Prehospital activation is strongly associated with reduced 30-day and 1-year cardiovascular mortality in STEMI patients.
Abstract:
Background Prehospital activation of the cardiac catheter laboratory is associated with significant improvements in ST-segment-elevation myocardial infarction (STEMI) performance measures. However, there are equivocal data, particularly within Australia, regarding its influence on mortality. We assessed the association of prehospital activation on performance measures and mortality in patients with STEMI treated with primary percutaneous coronary intervention from the Queensland Cardiac Outcomes Registry (QCOR). Methods and Results Consecutive ambulance-transported patients with STEMI treated with primary percutaneous coronary intervention were analyzed from January 1, 2017 to December 31, 2020 from the QCOR. The total and direct effects of prehospital activation on the primary outcomes (30-day and 1-year cardiovascular mortality) were estimated using logistic regression analyses. Secondary outcomes were STEMI performance measures. Among 2498 patients (mean age: 62.2±12.4 years; 79.2% male), 73% underwent prehospital activation. Median door-to-balloon time (34 minutes [26-46] versus 86 minutes [68-113]; P<0.001), first-electrocardiograph-to-balloon time (83.5 minutes [72-98] versus 109 minutes [81-139]; P<0.001), and proportion of patients meeting STEMI targets (door-to-balloon <60 minutes 90% versus 16%; P<0.001), electrocardiograph-to-balloon time <90 minutes (62% versus 33%; P<0.001) were significantly improved with prehospital activation. Prehospital activation was associated with significantly lower 30-day (1.6% versus 6.6%; P<0.001) and 1-year cardiovascular mortality (2.9% versus 9.5%; P<0.001). After adjustment, no prehospital activation was strongly associated with increased 30-day (odds ratio [OR], 3.6 [95% CI, 2.2-6.0], P<0.001) and 1-year cardiovascular mortality (OR, 3.0 [95% CI, 2.0-4.6]; P<0.001). Conclusions Prehospital activation of cardiac catheterization laboratory for primary percutaneous coronary intervention was associated with significantly shorter time to reperfusion, achievement of STEMI performance measures, and lower 30-day and 1-year cardiovascular mortality.
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