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Optimization of Emergency Care Pathway Beginning with Pre-admission Procedures for Patients with ST-elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: Impact on First Medical Contact to Balloon Time and Prognosis

DOI: 
10.7727/wimj.2015.560

ABSTRACT

Objectives: This study was conducted to compare the first medical contact to balloon time (FMC2B) and prognosis of patients with ST-elevation myocardial infarction (STEMI) receiving primary percutaneous coronary intervention (PCI) for two emergency care pathways, both beginning with a telephone call to the number 120 to reach Emergency Medical Services (EMS): 120 EMS -> Emergency Room -> Cardiac Catheterization Lab (optimized pathway); and 120 EMS -> Emergency Room -> Coronary Care Unit (CCU) -> Cardiac Catheterization Lab (conventional pathway).

Methods: A total of 183 patients with STEMI who were sent to the hospital by ambulance and received PCI within 12 hours after symptom onset was included in the study. These patients were divided into two groups: 100 were in the optimized pathway group and 83 were in the conventional pathway group. The primary endpoint was FMC2B time, and the secondary endpoints included the door-to-balloon (D2B) time, in-hospital mortality rate, recurrence rate for nonfatal myocardial infarction, cerebrovascular accident rate, heart failure rate, and rate of major cardiovascular events during the follow-up period. Multivariate regression analysis was performed to assess the risk factors for cardiovascular adverse events after the PCI procedure.

Results: Both the FMC2B time (100.3 min vs. 145.6 min, P<0.05) and D2B time (77.1 min vs. 115.4 min, P<0.05) were significantly shorter in the optimized pathway group than in the conventional pathway group. The in-hospital mortality rate was significantly lower in the optimized pathway group than in the conventional pathway group (5.0% vs. 15.7%, P<0.05). The rates of rehospitalization due to cardiovascular disease, all-cause death and cardiovascular death during the follow-up period were also all significantly lower in the optimized pathway group than in the conventional pathway group (χ2=5.17, χ2=8.15, χ2=4.55; all P<0.05). Multivariate regression analysis indicated that FMC2B time, D2B time and age were significantly correlated with cardiovascular event rate during the follow-up period (OR= 0.91, P=0.01; OR= 0.93, P=0.00; OR=0.74, P=0.02).

Conclusions: The optimized emergency care pathway, beginning with pre-admission procedures, can significantly shorten the FMC2B time and D2B time, and will improve the short- and long-term prognosis for STEMI patients.

Accepted: 
08 Feb, 2016
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e-Published: 22 Mar, 2016

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