Shorter Door-to-ECG Time Is Associated with Improved Mortality in STEMI Patients
Maame Yaa A B Yiadom1, Wu Gong2, Sean M Bloos3
1Department of Emergency Medicine, Stanford University, 900 Welch Road, Ste 350, Palo Alto, CA 94304, USA.
Insights
Timely electrocardiograms (ECG) within 10 minutes for ST-segment elevation myocardial infarction (STEMI) patients significantly reduce mortality. Consistent left ventricular ejection fraction (LVEF) assessment is crucial for evaluating STEMI care effectiveness.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Outcomes Research
Background:
- Delayed intervention in ST-segment elevation myocardial infarction (STEMI) correlates with increased mortality.
- The impact of door-to-ECG (D2E) timing on clinical outcomes in contemporary US STEMI populations remains under-explored.
Purpose of the Study:
- To investigate the association between timely (<10 min) versus untimely (>10 min) diagnostic ECG in the emergency department (ED) and mortality in STEMI patients.
- To explore left ventricular ejection fraction (LVEF) dysfunction and recovery among STEMI survivors.
Main Methods:
- A retrospective cohort study involving 10 centers over three years.
- Comparison of mortality rates between STEMI patients receiving timely vs. untimely diagnostic ECGs.
- Analysis of LVEF dysfunction during STEMI and post-discharge follow-up.
Main Results:
- One-week mortality was significantly lower in the timely ECG group (5%) compared to the untimely ECG group (10.2%; p=0.016).
- In-hospital mortality was also lower for timely ECGs (6.0%) versus untimely ECGs (10.9%; p=0.028).
- LVEF data were inconsistently available, limiting comprehensive analysis of dysfunction and recovery.
Conclusions:
- Achieving a D2E of under 10 minutes may halve mortality in ED STEMI patients.
- LVEF dysfunction is a key morbidity in STEMI survivors, yet its assessment was infrequent, hindering evaluation of survival-improving therapies.
- Standardized LVEF assessment is vital for future STEMI care intervention impact studies.
Abstract:
Background: Delayed intervention for ST-segment elevation myocardial infarction (STEMI) is associated with higher mortality. The association of door-to-ECG (D2E) with clinical outcomes has not been directly explored in a contemporary US-based population. Methods: This was a three-year, 10-center, retrospective cohort study of ED-diagnosed patients with STEMI comparing mortality between those who received timely (<10 min) vs. untimely (>10 min) diagnostic ECG. Among survivors, we explored left ventricular ejection fraction (LVEF) dysfunction during the STEMI encounter and recovery upon post-discharge follow-up. Results: Mortality was lower among those who received a timely ECG where one-week mortality was 5% (21/420) vs. 10.2% (26/256) among those with untimely ECGs (p = 0.016), and in-hospital mortality was 6.0% (25/420) vs. 10.9% (28/256) (p = 0.028). Data to compare change in LVEF metrics were available in only 24% of patients during the STEMI encounter and 46.5% on discharge follow-up. Conclusions: D2E within 10 min may be associated with a 50% reduction in mortality among ED STEMI patients. LVEF dysfunction is the primary resultant morbidity among STEMI survivors but was infrequently assessed despite low LVEF being an indication for survival-improving therapy. It will be difficult to assess the impact of STEMI care interventions without more consistent LVEF assessment.
More Related Videos
18:11A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
Published on: December 28, 2012
09:21Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Related Concept Videos
01:29Electrocardiogram
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and...
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...