Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-23T13:07:12.077Z Has data issue: false hasContentIssue false
  • English
  • Français

Effect of time to electrocardiogram on time from electrocardiogram to fibrinolysis in acute myocardial infarction patients

Published online by Cambridge University Press:  11 May 2015

Clare L. Atzema ,
Peter C. Austin ,
Jack V. Tu  and
Michael J. Schull
Clare L. Atzema*
Affiliation:
Institute for Clinical Evaluative Sciences, Toronto, ON Division of Emergency Medicine, Department of Medicine, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON
Peter C. Austin
Affiliation:
Institute for Clinical Evaluative Sciences, Toronto, ON
Jack V. Tu
Affiliation:
Institute for Clinical Evaluative Sciences, Toronto, ON Division of General Internal Medicine, Department of Medicine, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON
Michael J. Schull
Affiliation:
Institute for Clinical Evaluative Sciences, Toronto, ON Division of Emergency Medicine, Department of Medicine, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON
*
Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Room G147, Toronto, ON M4N 3M5; [email protected]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

The American Heart Association (AHA) recommends a benchmark door-to-electrocardiogram (ECG) time of 10 minutes for acute myocardial infarction patients, but this is based on expert opinion (level of evidence C). We sought to establish an evidence-based benchmark door-to-ECG time.

Methods:

This retrospective cohort study used a population-based sample of patients who suffered an ST elevation myocardial infarction (STEMI) in Ontario between 1999 and 2001. Using cubic smoothing splines, we described (1) the relationship between door-to-ECG time and ECG-to-needle time and (2) the proportion of STEMI patients who met the benchmark door-to-needle time of 30 minutes based on their door-to-ECG time. We hypothesized nonlinear relationships and sought to identify an inflection point in the latter curve that would define the most efficient (benefit the greatest number of patients) door-to-ECG time.

Results:

In 2,961 STEMI patients, the median door-to-ECG and ECG-to-needle times were 8.0 and 27.0 minutes, respectively. There was a linear increase in ECG-to-needle time as the door-to-ECG time increased, up to approximately 30 minutes, after which the ECG-to-needle time remained constant at 53 minutes. The inflection point in the probability of achieving the benchmark door-to-needle time occurred at 4 minutes, after which it decreased linearly, with every minute of door-to-ECG time decreasing the average probability of achievement by 2.2%.

Conclusions:

Hospitals that are not meeting benchmark reperfusion times may improve performance by decreasing door-to-ECG times, even if they are meeting the current AHA benchmark door-to-ECG time. The highest probability of meeting the reperfusion target time for fibrinolytic administration is associated with a door-to-ECG time of 4 minutes or less.

Keywords

acute myocardial infarctionbenchmark timesdoor-to-electrocardiogramemergency departmentfibrinolysis
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 13 , Issue 2 , March 2011 , pp. 79 - 89
Copyright
Copyright © Canadian Association of Emergency Physicians 2011

References

REFERENCES

1.Tu, JV, Ghali, W, Pilote, L, Brien, S, editors, Canadian Cardiovascular Outcomes Research Team. Canadian cardiovascular atlas. 2006. Available at: http://www.ccort.ca/CardiovascularAtlas/AtlasdescriptionDownloadAtlas/tabid/62/Default.aspx (accessed Jan 7, 2010).Google Scholar
2.American Heart Association. Heart disease and stroke statistics -2008 update. Dallas, Texas: American Heart Association; 2008.Google Scholar
3.National Center for Health Statistics. ED utilization and hospital discharge data; National Hospital Ambulatory Medical Care Survey. 2002. Available at: http://www.cdc.gov/nchs/data/ad/ad358.pdf (accessed Jan 7, 2010).Google Scholar
4.Antman, EM, Anbe, DT, Armstrong, PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction—executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). Circulation 2004;110:588–636.Google Scholar
5.Krumholz, HM, Anderson, JL, Brooks, NH, et al. ACC/AHA clinical performance measures for adults with ST-elevation and non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures on ST-Elevation and Non-ST-Elevation Myocardial Infarction). J Am Coll Cardiol 2006;47:236–65.Google Scholar
6.Kohn, MA, Kwan, E, Gupta, M, et al. Prevalence of acute myocardial infarction and other serious diagnoses in patients presenting to an urban emergency department with chest pain. J Emerg Med 2005;29:383–90.Google Scholar
7.Lindsell, CJ, Anantharaman, V, Diercks, D, et al. The Internet Tracking Registry of Acute Coronary Syndromes (i*trACS): a multicenter registry of patients with suspicion of acute coronary syndromes reported using the standardized reporting guidelines for emergency department chest pain studies. Ann Emerg Med 2006;48:666–77, 677.Google Scholar
8.Canto, JG, Shlipak, MG, Rogers, WJ, et al. Prevalence, clinical characteristics, and mortality among patients with myocardial infarction presenting without chest pain. JAMA 2000;283:3223–9.CrossRefGoogle ScholarPubMed
9.Derlet, R, Richards, J, Kravitz, R. Frequent overcrowding in U.S. emergency departments. Acad Emerg Med 2001;8:151–5.CrossRefGoogle ScholarPubMed
10.Proudlove, NC, Gordon, K, Boaden, R. Can good bed management solve the overcrowding in accident and emergency departments? Emerg Med J 2003;20:149–55.Google Scholar
11.Rowe, B, Bond, K, Ospina, B, et al. Frequency, determinants, and impact of overcrowding on emergency departments in Canada: a national survey of emergency department directors. Ottawa: Canadian Agencies for Drugs and Technologies in Health; 2006. Technology Report No.: 67.3.Google Scholar
12.De Luca, G, Suryapranata, H, Ottervanger, JP, et al. Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts. Circulation 2004;109:1223–5.Google Scholar
13.Fibrinolytic Therapy Trialists’ (FTT) Collaborative Group. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Lancet 1994;343:311–22.Google Scholar
14.Eagle, KA, Nallamothu, BK, Mehta, RH, et al. Trends in acute reperfusion therapy for ST-segment elevation myocardial infarction from 1999 to 2006: we are getting better but we have got a long way to go. Eur Heart J 2008;29:609–17.Google Scholar
15.Gibson, CM, Pride, YB, Frederick, PD, et al. Trends in reperfusion strategies, door-to-needle and door-to-balloon times, and in-hospital mortality among patients with STsegment elevation myocardial infarction enrolled in the National Registry of Myocardial Infarction from 1990 to 2006. Am Heart J 2008;156:1035–44.CrossRefGoogle Scholar
16.Nallamothu, BK, Wang, Y, Bradley, EH, et al. Comparing hospital performance in door-to-balloon time between the Hospital Quality Alliance and the National Cardiovascular Data Registry. J Am Coll Cardiol 2007;50:1517–9.CrossRefGoogle ScholarPubMed
17.Tu, JV, Donovan, LR, Lee, DS, et al. Quality of cardiac care in Ontario. Phase 1. Report 1. January 1, 2004. Available at: http://www.ccort.ca/EFFECT.aspx (accessed Jan 7, 2010).Google Scholar
18.Tu, JV, Donovan, LR, Austin, PA, et al. Quality of cardiac care in Ontario. Phase I. Report 2. January 9, 2005. Available at: http://www.ccort.ca/EFFECT.aspx (accessed Jan 7, 2010).Google Scholar
19.Lee, DS, Austin, PC, Rouleau, JL, et al. Predicting mortality among patients hospitalized for heart failure: derivation and validation of a clinical model. JAMA 2003;290:2581–7.CrossRefGoogle ScholarPubMed
20.Tu, JV, Naylor, CD, Austin, P. Temporal changes in the outcomes of acute myocardial infarction in Ontario, 1992-1996. CMAJ 1999;161:1257–61.Google ScholarPubMed
21.Alpert, JS, Thygesen, K, Antman, E, et al. Myocardial infarction redefined—a consensus document of the Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. J Am Coll Cardiol 2000;36:959–69.Google Scholar
22.Herndon, JE, Harrell, FE Jr.The restricted cubic spline as baseline hazard in the proportional hazards model with step function time-dependent covariables. Stat Med 1995;14:2119–29.Google Scholar
23.Austin, PC, Tu, JV, Daly, PA, et al. The use of quantile regression in health care research: a case study examining gender differences in the timeliness of thrombolytic therapy. Stat Med 2005;24:791–816.Google Scholar
24.Bradley, EH, Herrin, J, Wang, Y, et al. Strategies for reducing the door-to-balloon time in acute myocardial infarction. N Engl J Med 2006;355:2308–20.Google Scholar
25.Atzema, CL, Austin, PC, Tu, JV, et al. Emergency department triage of acute myocardial infarction patients and the effect on outcomes. Ann Emerg Med 2009;53:736–45.Google Scholar
26.Graff, L, Palmer, AC, Lamonica, P, et al. Triage of patients for a rapid (5-minute) electrocardiogram: a rule based on presenting chief complaints. Ann Emerg Med 2000;36:554–60.CrossRefGoogle ScholarPubMed
27.Qasim, A, Malpass, K, O’Gorman, DJ, et al. Safety and efficacy of nurse initiated thrombolysis in patients with acute myocardial infarction. BMJ 2002;324:1328–31.Google Scholar
28.Eskola, MJ, Nikus, KC, Voipio-Pulkki, LM, et al. Comparative accuracy of manual versus computerized electrocardiographic measurement of J-, ST- and T-wave deviations in patients with acute coronary syndrome. Am J Cardiol 2005;96:1584–8.Google Scholar
29.Massel, D, Dawdy, JA, Melendez, LJ. Strict reliance on a computer algorithm or measurable ST segment criteria may lead to errors in thrombolytic therapy eligibility. Am Heart J 2000;140:221–6.Google Scholar
30.Ting, HH, Krumholz, HM, Bradley, EH, et al. Implementation and integration of prehospital ECGs into systems of care for acute coronary syndrome: a scientific statement from the American Heart Association Interdisciplinary Council on Quality of Care and Outcomes Research, Emergency Cardiovascular Care Committee, Council on Cardiovascular Nursing, and Council on Clinical Cardiology. Circulation 2008;118:1066–79.Google Scholar
31.Canto, JG, Zalenski, RJ, Ornato, JP, et al. Use of emergency medical services in acute myocardial infarction and subsequent quality of care: observations from the National Registry of Myocardial Infarction 2. Circulation 2002;106:3018–23.Google Scholar
32.Williams, DM. 2006 JEMS 200-city survey. EMS from all angles. JEMS 2007;32:38–42, 44, 46.Google Scholar
33.Schull, MJ, Vaillancourt, S, Donovan, L, et al. Underuse of prehospital strategies to reduce time to reperfusion for STelevation myocardial infarction patients in 5 Canadian provinces. CJEM 2009;11:473–80.Google Scholar
34.Berger, AK, Radford, MJ, Krumholz, HM. Factors associated with delay in reperfusion therapy in elderly patients with acute myocardial infarction: analysis of the cooperative cardiovascular project. Am Heart J 2000;139:985–92.CrossRefGoogle ScholarPubMed
35.Brophy, JM, Diodati, JG, Bogaty, P, et al. The delay to thrombolysis: an analysis of hospital and patient characteristics. Quebec Acute Coronary Care Working Group. CMAJ 1998;158:475–80.Google ScholarPubMed
36.Newby, LK, Rutsch, WR, Califf, RM, et al. Time from symptom onset to treatment and outcomes after thrombolytic therapy. GUSTO-1 Investigators. J Am Coll Cardiol 1996;27:1646–55.Google Scholar
37.Magid, DJ, Wang, Y, Herrin, J, et al. Relationship between time of day, day of week, timeliness of reperfusion, and in-hospital mortality for patients with acute ST-segment elevation myocardial infarction. JAMA 2005;294:803–12.CrossRefGoogle ScholarPubMed
38.Lambrew, CT, Bowlby, LJ, Rogers, WJ, et al. Factors influencing the time to thrombolysis in acute myocardial infarction. Time to Thrombolysis Substudy of the National Registry of Myocardial Infarction-1. Arch Intern Med 1997;157:2577–82.Google Scholar
39.Sharkey, SW, Bruneete, DD, Ruiz, E, et al. An analysis of time delays preceding thrombolysis for acute myocardial infarction. JAMA 1989;262:3171–4.CrossRefGoogle ScholarPubMed
40.Atzema, CL, Austin, P, Tu, JV, Schull, MJ. ED triage of patients with acute myocardial infarction: predictors of low acuity triage. Am J Emerg Med 2010;28:694–702.Google Scholar
41.Diercks, DB, Kirk, JD, Lindsell, CJ, et al. Door-to-ECG time in patients with chest pain presenting to the ED. Am J Emerg Med 2006;24:1–7.Google Scholar
42.Parikh, SV, Jacobi, JA, Chu, E, et al. Treatment delay in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction: a key process analysis of patient and program factors. Am Heart J 2008;155:290–7.Google Scholar
43.McNamara, RL, Herrin, J, Bradley, EH, et al. Hospital improvement in time to reperfusion in patients with acute myocardial infarction, 1999 to 2002. J Am Coll Cardiol 2006;47:45–51.Google Scholar
44.Boden, WE, Eagle, K, Granger, CB. Reperfusion strategies in acute ST-segment elevation myocardial infarction: a comprehensive review of contemporary management options. J Am Coll Cardiol 2007;50:917–29.Google Scholar
45.Tu, JV, Donovan, LR, Lee, DS, et al. Effectiveness of public report cards for improving the quality of cardiac care: the EFFECT study: a randomized trial. JAMA 2009;302:2330–7.Google Scholar