(Circulation. 2010;122:1464-1469.) © 2010 American Heart Association, Inc.
Coronary Heart Disease
Association Between Prehospital Time Intervals and ST-Elevation Myocardial Infarction System Performance
Jonathan R. Studnek, PhD; Lee Garvey, MD; Tom Blackwell, MD; Steven Vandeventer; Steven R. Ward
From the Carolinas Medical Center, Center for Prehospital Medicine (J.R.S.) and Department of Emergency Medicine (L.G., T.B.), and Mecklenburg EMS Agency (J.R.S., S.V., S.R.W.), Charlotte, NC.
Correspondence to Jonathan R. Studnek, PhD, NREMT-P, Carolinas Medical Center, Center for Prehospital Medicine, PO Box 32861, Charlotte, NC 28232. E-mail firstname.lastname@example.org
Background— Among individuals experiencing an ST segment–elevation myocardial infarction, current guidelines recommend that the interval from first medical contact to percutaneous coronary intervention be 90 minutes. The objective of this study was to determine whether prehospital time intervals were associated with ST-elevation myocardial infarction system performance, defined as first medical contact to percutaneous coronary intervention.
Methods and Results— Study patients presented with an acute ST-elevation myocardial infarction diagnosed by prehospital ECG between May 2007 and March 2009. Prehospital time intervals were as follows: 9-1-1 call receipt to ambulance on scene 10 minutes, ambulance on scene to 12-lead ECG acquisition 8 minutes, on-scene time 15 minutes, prehospital ECG acquisition to ST-elevation myocardial infarction team notification 10 minutes, and scene departure to patient on cardiac catheterization laboratory table 30 minutes. Time intervals were derived and analyzed with descriptive statistics and logistic regression. There were 181 prehospital patients who received percutaneous coronary intervention, with 165 (91.1) having complete data. Logistic regression indicated that table time, response time, and
on-scene time were the benchmark time intervals with the greatest influence on the probability of achieving percutaneous coronary intervention in 90 minutes. Individuals with a time from scene departure to arrival on cardiac catheterization laboratory table of 30 minutes were 11.1 times (3.4 to 36.0) more likely to achieve percutaneous coronary intervention in 90 minutes than those with extended table times.
Conclusions— In this patient population, prehospital timing benchmarks were associated with system performance. Although meeting all 5 benchmarks may be an ideal goal, this model may be more useful for identifying areas for system improvement that will have the greatest clinical impact.