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Pre-hospital Transport Times and Outcomes After Different Reperfusion Strategies for ST-Elevation Myocardial Infarction.
Am J Cardiol 2019; 123(3):375-381AJ

Abstract

This study evaluated prehospital transport times and clinical outcomes after different reperfusion strategies for ST-elevation myocardial infarction in a real-world setting. We consecutively enrolled 27,205 patients who underwent percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction in Michigan from 2010 to 2016. Primary PCI was performed in 25,927 patients (95%), whereas 1,278 (5%) were treated with a pharmacoinvasive strategy. The overall use of a pharmacoinvasive strategy decreased during the study period (p <0.001). Prehospital transport times were estimated by using the Google Maps API from the centroid of each home zip code tabulation area to the zip code tabulation area for the nearest hospital with PCI capability. The estimated prehospital transport time predicted the choice of reperfusion strategy (p <0.001). Primary PCI was used in 97% of the patients living within 1 hour from a hospital with PCI capability compared with 48% with estimated transport times >1 hour. Bleeding and mortality rates were similar for patients treated with primary PCI or a pharmacoinvasive strategy (odds ratio 0.832, 95% confidence interval 0.649 to 1.067, p = 0.147). In conclusion, almost all patients in Michigan had timely access to a hospital with PCI capability and received treatment with primary PCI. The authors declare no conflicts of interests.

Authors+Show Affiliations

Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan; Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. Electronic address: anderssonhedvig@gmail.com.Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan.Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan.Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30545480

Citation

Andersson, Hedvig B., et al. "Pre-hospital Transport Times and Outcomes After Different Reperfusion Strategies for ST-Elevation Myocardial Infarction." The American Journal of Cardiology, vol. 123, no. 3, 2019, pp. 375-381.
Andersson HB, Seth M, Gurm HS, et al. Pre-hospital Transport Times and Outcomes After Different Reperfusion Strategies for ST-Elevation Myocardial Infarction. Am J Cardiol. 2019;123(3):375-381.
Andersson, H. B., Seth, M., Gurm, H. S., & Bates, E. R. (2019). Pre-hospital Transport Times and Outcomes After Different Reperfusion Strategies for ST-Elevation Myocardial Infarction. The American Journal of Cardiology, 123(3), pp. 375-381. doi:10.1016/j.amjcard.2018.10.015.
Andersson HB, et al. Pre-hospital Transport Times and Outcomes After Different Reperfusion Strategies for ST-Elevation Myocardial Infarction. Am J Cardiol. 2019 02 1;123(3):375-381. PubMed PMID: 30545480.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pre-hospital Transport Times and Outcomes After Different Reperfusion Strategies for ST-Elevation Myocardial Infarction. AU - Andersson,Hedvig B, AU - Seth,Milan, AU - Gurm,Hitinder S, AU - Bates,Eric R, Y1 - 2018/10/21/ PY - 2018/02/28/received PY - 2018/10/09/revised PY - 2018/10/10/accepted PY - 2018/12/14/pubmed PY - 2018/12/14/medline PY - 2018/12/15/entrez SP - 375 EP - 381 JF - The American journal of cardiology JO - Am. J. Cardiol. VL - 123 IS - 3 N2 - This study evaluated prehospital transport times and clinical outcomes after different reperfusion strategies for ST-elevation myocardial infarction in a real-world setting. We consecutively enrolled 27,205 patients who underwent percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction in Michigan from 2010 to 2016. Primary PCI was performed in 25,927 patients (95%), whereas 1,278 (5%) were treated with a pharmacoinvasive strategy. The overall use of a pharmacoinvasive strategy decreased during the study period (p <0.001). Prehospital transport times were estimated by using the Google Maps API from the centroid of each home zip code tabulation area to the zip code tabulation area for the nearest hospital with PCI capability. The estimated prehospital transport time predicted the choice of reperfusion strategy (p <0.001). Primary PCI was used in 97% of the patients living within 1 hour from a hospital with PCI capability compared with 48% with estimated transport times >1 hour. Bleeding and mortality rates were similar for patients treated with primary PCI or a pharmacoinvasive strategy (odds ratio 0.832, 95% confidence interval 0.649 to 1.067, p = 0.147). In conclusion, almost all patients in Michigan had timely access to a hospital with PCI capability and received treatment with primary PCI. The authors declare no conflicts of interests. SN - 1879-1913 UR - https://www.unboundmedicine.com/medline/citation/30545480/Pre-hospital_Transport_Times_and_Outcomes_After_Different_Reperfusion_Strategies_for_ST-Elevation_Myocardial_Infarction L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(18)31973-8 DB - PRIME DP - Unbound Medicine ER -