Coronary artery diseaseAn Approach to Shorten Time to Infarct Artery Patency in Patients With ST-Segment Elevation Myocardial Infarction
Section snippets
Setting
The PCI hospital is a 356-bed regional referral center. The catchment area includes 3 rural counties in Oregon and northern California having 4 community hospitals located 2, 12, 32, and 52 miles away from a regional medical center. The study was initiated between June 2003 and December 2004 as part of a regional quality-improvement project to decrease PCI treatment delays for patients with STEMI.
Protocol
The protocol was implemented through the collaboration of 16 cardiologists from 2 practice groups,
Data verification and selection of cases
Cases were identified by retrospective review by a data analyst (KAB). A random sample of 30 cases was selected for inter-rater reliability confirmation by the cardiology primary investigator (BWG). All data were verified for accuracy between the data analyst (KAB) and a statistical data analyst (AMR). Discrepancies were resolved by consensus.
Patient baseline characteristics
From June 2003 to December 2004, 233 consecutive patients met protocol criteria for the diagnosis of STEMI. Their mean age was 66.1 ± 11.9 years; ∼75%
Discussion
A coordinated, prehospital, regional emergency response for patients with STEMI markedly improved time to PCI. The protocol required <6 hours of “heart equivalent discomfort,” a diagnostic electrocardiogram showing STEMI, and direct triage by paramedics to the prealerted PCI hospital, often bypassing other smaller hospitals. There were significant time savings to achieving an open artery for patients initially seen by paramedics compared with regional hospital ED walk-in patients who were
Acknowledgment
We thank Karen A. Bales, RN, BSN, Dr. Douglas Burwell, Dr. Nicholas Dienel, Dr. John Forsyth, Dr. Gary Foster, Dr. Michael Fugit, Dr. Mark Huth, Dr. Ken Lightheart, Dr. David Martin, Dr. Minor Mathews, Dr. Brian Morrison, Dr. Bruce Patterson, Dr. Eric Pena, Dr. Brad Personious, Dr. Richard Schaefer, Mercy Flights, American Medical Response, Ashland Fire & Rescue, Rogue River Fire District, Northern Siskiyou Ambulance, Medford Fire Department, Jackson County Fire District #3, Rogue Valley
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