Background
Many strategies exist, and each has been implemented with the goal of decreasing the time between arrival at the hospital and intracoronary balloon inflation, the door-to-balloon time (D2B). Improving D2B time strategies can result in increasing false-positive STEMI recognition and increasing resource utilization. It is estimated that about US$ 5000 are spent every time the cardiac catheterization laboratory (cath lab) team is activated and later cancelled. We evaluated two strategies—emergency medical services (EMS) activation (prehospital activation) and emergency physician (ER) activation (in-hospital activation)—to compare outcomes.
Results
The number of STEMI patients evaluated during the EMS activation strategy was 101 (73% male, mean age: 61 years). Cardiac catheterization team was activated for all 101 patients; 32 underwent catheterization, of which 22 received primary percutaneous coronary intervention (PPCI), 3 were referred for CABG, and the remaining 69 patients cancelled the catheterization due to false-positive STEMI activation. During the ER activation strategy, 171 STEMI patients were evaluated (63% male, mean age: 61 years). EMS diagnosed STEMI in all 171 cases, but ER physician activated the cath lab team for 29. All underwent cardiac catheterization, with 26 receiving PPCI and the remaining 3 receiving medical therapy. The difference in resource utilization as evaluated by the decrease of false-positive activations was statistically significant ( P <.01), with the mean D2B time and mortality in the EMS and ER activation strategies being 64.8±4.4 min and 6%, and 69.2±3.6 min and 7%, respectively (not significant).
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