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Bypassing ED may improve reperfusion times in STEMI patients
In patients identified pre-hospital with STEMI, researchers found a median of 30 minutes was spent in the ED, which contributed significantly to failing to achieve timely reperfusion, whereas those who were transferred directly from the field to the cath lab had significantly shorter times to reperfusion.
Researchers examined data from July 2008 to December 2009 for 1,687 patients from the Reperfusion in Acute Myocardial Infarction in Carolina Emergency Departments (RACE) project. All patients were identified pre-hospital with STEMI and were transported directly to 21 North Carolina hospitals by emergency medical service for primary PCI.
Researchers compared the treatment time intervals between patients evaluated in the ED first (n=1,401; 83%) with those transported directly to the cath lab (n= 286; 17%).
For all patients combined, researchers found that first medical contact to device activation was achieved within 90 minutes in 913 patients (54.1%). For patients who were transported to the ED first, the median time spent before arriving at the cath lab was 30 minutes.
First medical contact to device activation occurred faster on average in patients who were taken directly to the cath lab compared with those evaluated in the ED first (75 vs. 90 minutes; P<.001). First medical contact to device activation was more frequently achieved within 90 minutes among patients who bypassed the ED compared with those who spent time in the ED (74.1% vs. 50.1%; P<.001).
“Even with pre-hospital identification of STEMI, and direct transport to a PCI center, only one in two patients achieved device activation within the guideline-based target time. For patients brought to the ED, a median of 30 minutes is spent in the ED before arrival in the cath lab, contributing significantly to the failure to achieve timely reperfusion,” the researchers wrote. “The strategy to transport patients from the field directly to the cath lab, thereby bypassing the ED, is used infrequently and represents a potential opportunity to achieve faster reperfusion.”
Disclosure: Bagai reports no relevant financial disclosures