Outcomes of a Provincial Myocardial Infarction Reperfusion Strategy: A Population-Based, Retrospective Cohort Study

被引:3
作者
Cook, Jolene [1 ,2 ,3 ,4 ]
Carter, Alix [1 ,2 ,3 ,4 ]
Goldstein, Judah [1 ,3 ]
Travers, Andrew [1 ,2 ,3 ,4 ]
Brown, Ryan [1 ,3 ]
Swain, Janel [1 ]
Jensen, Jan [1 ,3 ,4 ]
Matheson, Kara [5 ]
Cain, Ed [1 ,2 ,3 ,4 ]
Lee, Tony [4 ,6 ]
机构
[1] Emergency Hlth Serv, Halifax, NS, Canada
[2] Dalhousie Univ, Dept Emergency Med, Halifax, NS, Canada
[3] Dalhousie Univ, Div EMS, Halifax, NS, Canada
[4] Nova Scotia Hlth Author, Halifax, NS, Canada
[5] Nova Scotia Hlth Author, Res Methods Unit, Halifax, NS, Canada
[6] Dalhousie Univ, Div Cardiol, Halifax, NS, Canada
关键词
EMS; fibrinolysis; myocardial infarction; STEMI; ELEVATION; ANGIOPLASTY; GUIDELINES; MANAGEMENT; TIME; CARE;
D O I
10.1017/S1049023X20000801
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: Fibrinolysis is an acceptable treatment for acute ST-segment elevation myocardial infarction (STEMI) when primary percutaneous coronary intervention (PCI) cannot be performed within 120 minutes. The American Heart Association has recommended Emergency Medical Services (EMS) interventions such as prehospital fibrinolysis (PHF), prehospital electrocardiogram (ECG), and hospital bypass direct to PCI center. Nova Scotia, Canada has incorporated these interventions into a unique province-wide approach to STEMI care. A retrospective cohort analysis comparing the primary outcome of 30-day mortality for patients receiving either prehospital or emergency department (ED) fibrinolysis (EDF) to patients transported directly by EMS from community or regional ED for primary PCI was conducted. Methods: This retrospective, population-based cohort study included all STEMI patients in Nova Scotia who survived to hospital admission from July 2011 through July 2013. Three provincial databases were used to collect demographic, 30-day mortality, hospital readmission, and rescue PCI data. The results were grouped and compared according to reperfusion strategy received: PHF, EDF, patients brought by ambulance via EMS direct to PCI (EMS to PCI), and ED to PCI (ED to PCI). Results: There were 1,071 STEMI patients included with 145 PHF, 606 EDF, 98 EMS to PCI, and 222 ED to PCI. There were no significant differences in 30-day mortality across groups (n, %): PHF 5(3); EDF 36(6); EHS to PCI <5(2); and ED to PCI 10(4); P = .28. There was no significant difference in patients receiving fibrinolysis who underwent rescue PCI. Conclusions: Prehospital fibrinolysis incorporated into a province-wide approach to STEMI treatment is feasible with no observed difference in patient 30-day mortality outcomes observed.
引用
收藏
页码:528 / 532
页数:5
相关论文
共 15 条
  • [1] Bypassing the Emergency Department to Improve the Process of Care for ST-Elevation Myocardial Infarction: Necessary but Not Sufficient
    Antman, Elliott M.
    [J]. CIRCULATION, 2013, 128 (04) : 322 - 324
  • [2] The Strategic Reperfusion Early After Myocardial Infarction (STREAM) study
    Armstrong, Paul W.
    Gershlick, Anthony
    Goldstein, Patrick
    Wilcox, Robert
    Danays, Thierry
    Bluhmki, Erich
    Van de Werf, Frans
    [J]. AMERICAN HEART JOURNAL, 2010, 160 (01) : 30 - U49
  • [3] Routine Early Angioplasty after Fibrinolysis for Acute Myocardial Infarction
    Cantor, Warren J.
    Fitchett, David
    Borgundvaag, Bjug
    Ducas, John
    Heffernan, Michael
    Cohen, Eric A.
    Morrison, Laurie J.
    Langer, Anatoly
    Dzavik, Vladimir
    Mehta, Shamir R.
    Lazzam, Charles
    Schwartz, Brian
    Casanova, Amparo
    Goodman, Shaun G.
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 2009, 360 (26) : 2705 - 2718
  • [4] Emergency Health Services (EHS) Nova Scotia Department of Health, 2018, PROT STEMI RESTORE
  • [5] 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation
    Ibanez, Borja
    James, Stefan
    Agewall, Stefan
    Antunes, Manuel J.
    Bucciarelli-Ducci, Chiara
    Bueno, Hector
    Caforio, Alida L. P.
    Crea, Filippo
    Goudevenos, John A.
    Halvorsen, Sigrun
    Hindricks, Gerhard
    Kastrati, Adnan
    Lenzen, Mattie J.
    Prescott, Eva
    Roffi, Marco
    Valgimigli, Marco
    Varenhorst, Christoph
    Vranckx, Pascal
    Widimsky, Petr
    [J]. KARDIOLOGIA POLSKA, 2018, 76 (02) : 229 - 313
  • [6] PARAMEDIC MYOCARDIAL INFARCTION CARE WITH FIBRINOLYTICS: A PROCESS MAP AND HAZARD ANALYSIS
    Jensen, Jan L.
    Walker, Mark
    Denike, Doug
    Matthews, Victor
    Boudreau, Christopher
    Hill, William
    Travers, Andrew
    [J]. PREHOSPITAL EMERGENCY CARE, 2013, 17 (04) : 429 - 434
  • [7] Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials
    Keeley, EC
    Boura, JA
    Grines, CL
    [J]. LANCET, 2003, 361 (9351) : 13 - 20
  • [8] The Role of Paramedics in a Primary PCI Program for ST-Elevation Myocardial Infarction
    Le May, Michel R.
    Dionne, Richard
    Maloney, Justin
    Poirier, Pierre
    [J]. PROGRESS IN CARDIOVASCULAR DISEASES, 2010, 53 (03) : 183 - 187
  • [9] Pre-hospital versus in-hospital thrombolysis for ST-elevation myocardial infarction
    McCaul, Michael
    Lourens, Andrit
    Kredo, Tamara
    [J]. COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2014, (09):
  • [10] Mortality and prehospital thrombolysis for acute myocardial infarction - A meta-analysis
    Morrison, LJ
    Verbeck, PR
    McDonald, AC
    Sawadsky, BV
    Cook, DJ
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2000, 283 (20): : 2686 - 2692