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Prehospital STEMI

Surya Dharma, Hananto Andriantoro, Ismi Purnawan, Iwan Dakota, Faris Basalamah, Beny Hartono, Ronaly Rasmin, Herawati Isnanijah, Muhammad Yamin, Ika Prasetya Wijaya, Vireza Pratama, Tjatur Bagus Gunawan, Yahya Berkahanto Juwana, Frits R W Suling, A M Onny Witjaksono, Hengkie F Lasanudin, Kurniawan Iskandarsyah, Hardja Priatna, Pradana Tedjasukmana, Uki Wahyumandradi, Adrianus Kosasih, Imelda A Budhiarti, Wisnoe Pribadi, Jeffrey Wirianta, Utojo Lubiantoro, Rini Pramesti, Diah Retno Widowati, Sissy Kartini Aminda, M Abas Basalamah, Sunil V Rao
OBJECTIVE: We studied the characteristics of patients with ST segment elevation myocardial infarction (STEMI) after expansion of a STEMI registry as part of the STEMI network programme in a metropolitan city and the surrounding area covering ∼26 million inhabitants. DESIGN: Retrospective cohort study. SETTING: Emergency department of 56 health centres. PARTICIPANTS: 3015 patients with acute coronary syndrome, of which 1024 patients had STEMI...
2016: BMJ Open
Edward Lance Callachan, Alawi A Alsheikh-Ali, Satish Chandrasekhar Nair, Stevan Bruijns, Lee A Wallis
BACKGROUND: Data on the use of emergency medical services (EMS) by patients with cardiac conditions in the Gulf region are scarce, and prior studies have suggested underutilization. Patient perception and knowledge of EMS care is critical to proper utilization of such services. OBJECTIVES: To estimate utilization, knowledge, and perceptions of EMS among patients with ST-elevation myocardial infarction (STEMI) in the Emirate of Abu Dhabi. METHODS: We conducted a multicenter prospective study of consecutive patients admitted with STEMI in four government-operated hospitals in Abu Dhabi...
April 2016: Heart Views: the Official Journal of the Gulf Heart Association
T Viergutz, J Grüttner, T Walter, C Weiss, B Haaff, G Pollach, C Madler, T Luiz
BACKGROUND: In the current guidelines for the treatment of patients with ST-segment elevation myocardial infarction (STEMI), the European Society of Cardiology (ESC) recommends preclinical fibrinolysis as a reperfusion therapy if, due to long transportation times, no cardiac catheterisation is available within 90-120 min. However, there is little remaining in-depth expertise in this method because fibrinolysis is presently only rarely indicated. METHODS: In a rural area in southwestern Germany, where an emergency primary percutaneous coronary intervention was not routinely available within 90-120 min, 156 STEMI patients underwent fibrinolysis with the plasminogen activator reteplase, performed by trained emergency physicians...
September 2016: Der Anaesthesist
Katherine Choi, Frances S Shofer, Angela M Mills
OBJECTIVE: The objective was to determine whether sex was independently associated with door to ST-elevation myocardial infarction (STEMI) activation time. We hypothesized that women are more likely to experience longer delays to STEMI activation than men. METHODS: We conducted a retrospective cohort study of adults ≥18 years who underwent STEMI activation at 3 urban emergency departments between 2010 and 2014. The Wilcoxon rank sum test and logistic regression were used to compare men and women regarding time to activation and proportion with times <15 minutes, respectively...
June 29, 2016: American Journal of Emergency Medicine
Akihiro Kobayashi, Naoki Misumida, Shunsuke Aoi, Eric Steinberg, Kathleen Kearney, John T Fox, Yumiko Kanei
BACKGROUND: Emergency medical services (EMS) transportation is associated with shorter door-to-balloon (DTB) time in patients with ST-segment elevation myocardial infarction (STEMI). In addition to EMS transportation, prehospital notification of STEMI by EMS to receiving hospital might be able to further shorten DTB time. We evaluated the impact of STEMI notification on DTB time as well as infarct size. METHODS: We performed a retrospective analysis of consecutive patients with anterior wall STEMI who underwent emergent coronary angiography...
August 2016: American Journal of Emergency Medicine
Shoji Kawakami, Yoshio Tahara, Teruo Noguchi, Nobuhito Yagi, Yu Kataoka, Yasuhide Asaumi, Michio Nakanishi, Yoichi Goto, Hiroyuki Yokoyama, Hiroshi Nonogi, Hisao Ogawa, Satoshi Yasuda
BACKGROUND: Prehospital ECG improves survival following ST-segment elevation myocardial infarction (STEMI). Although a new International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations placed new emphasis on the role of prehospital ECG, this technology is not widely used in Japan. We developed a mobile telemedicine system (MTS) that continuously transmits real-time 12-lead ECG from ambulances in a prehospital setting...
June 24, 2016: Circulation Journal: Official Journal of the Japanese Circulation Society
J Lee Garvey, Jessica Zegre-Hemsey, Richard Gregg, Jonathan R Studnek
OBJECTIVE: To assess the validity of three different computerized electrocardiogram (ECG) interpretation algorithms in correctly identifying STEMI patients in the prehospital environment who require emergent cardiac intervention. METHODS: This retrospective study validated three diagnostic algorithms (AG) against the presence of a culprit coronary artery upon cardiac catheterization. Two patient groups were enrolled in this study: those with verified prehospital ST-elevation myocardial infarction (STEMI) activation (cases) and those with a prehospital impression of chest pain due to ACS (controls)...
September 2016: Journal of Electrocardiology
Patrick Goldstein, Niccolò Grieco, Hüseyin Ince, Nicolas Danchin, Yvonne Ramos, Jochen Goedicke, Peter Clemmensen
AIM: MULTIPRAC was designed to provide insights into the use and outcomes associated with prehospital initiation of antiplatelet therapy with either prasugrel or clopidogrel in the context of primary percutaneous coronary intervention. After a previous report on efficacy and safety outcomes during hospitalization, we report here the 1-year follow-up data, including cardiovascular (CV) mortality. METHODS AND RESULTS: MULTIPRAC is a multinational, prospective registry of patients with ST-elevation myocardial infarction (STEMI) from 25 hospitals in nine countries, all of which had an established practice of prehospital start of dual antiplatelet therapy in place...
2016: Vascular Health and Risk Management
Lieven Annemans, Nicolas Danchin, Frans Van de Werf, Stuart Pocock, Muriel Licour, Jesús Medina, Héctor Bueno
OBJECTIVE: The aim of this report is to provide insight into real-world healthcare resource use (HCRU) during the critical management of patients surviving acute coronary syndromes (ACS), using data from EPICOR (long-tErm follow-up of antithrombotic management Patterns In acute CORonary syndrome patients) (NCT01171404). METHODS: EPICOR was a prospective, multinational, observational study that enrolled 10 568 ACS survivors from 555 hospitals in 20 countries in Europe and Latin America, between September 2010 and March 2011...
2016: Open Heart
Amirreza Solhpour, Kay-Won Chang, Salman A Arain, Prakash Balan, Yelin Zhao, Catalin Loghin, James J McCarthy, H Vernon Anderson, Richard W Smalling
OBJECTIVES: We investigated whether prehospital, reduced dose fibrinolysis coupled with urgent percutaneous coronary intervention (FAST-PCI) reduces mortality and cardiac magnetic resonance (CMR) measures of infarct size, compared with primary percutaneous coronary intervention (PPCI), in patients with ST-elevation myocardial infarction (STEMI). BACKGROUND: Current standard therapy for STEMI is PPCI. However, FAST-PCI may shorten ischemic time (IT) and improve outcomes...
March 29, 2016: Catheterization and Cardiovascular Interventions
Christopher B Fordyce, John A Cairns, Joel Singer, Terry Lee, Julie E Park, Richard A Vandegriend, Michele Perry, Wendy Largy, Min Gao, Krishnan Ramanathan, Graham C Wong
BACKGROUND: We describe the evolution of a regional system designed to provide primary percutaneous coronary intervention (pPCI) as the preferred method of revascularization for ST-elevation myocardial infarction (STEMI) and its impact on first medical contact (FMC)-to-device times and in-hospital outcomes. METHODS: Patients with STEMI presenting to the Vancouver Coastal Health Authority between June 2007 and January 2015 (N = 2503) were categorized according to 3 sequential phases: phase 1 = standardization of reperfusion algorithms; phase 2 = use of prehospital electrocardiograms; phase 3 = expedited interfacility transfer for pPCI...
December 19, 2015: Canadian Journal of Cardiology
Paul I Musey, Jonathan R Studnek, Lee Garvey
OBJECTIVES: To assess the clinical and electrocardiographic characteristics of patients diagnosed with ST elevation myocardial infarction (STEMI) that are associated with an increased likelihood of not undergoing percutaneous coronary intervention (PCI) after prehospital Cardiac Catheterization Laboratory activation in a regional STEMI system. METHODS: We performed a retrospective analysis of prehospital Cardiac Catheterization Laboratory activations in Mecklenburg County, North Carolina, between May 2008 and March 2011...
March 2016: Critical Pathways in Cardiology
Mary Colleen Bhalla, Jennifer Frey, Sarah Dials, Kristin Baughman
BACKGROUND: Non-ST-segment elevation myocardial infarctions (NSTEMIs) are more common but less studied than ST-segment elevation myocardial infarctions (STEMIs) treated by emergency medical services (EMS). OBJECTIVE: The purpose of this study was to evaluate the differences in baseline characteristics and outcomes of NSTEMI patients when arriving by EMS vs self-transport. METHODS: We performed a retrospective medical record review of 96 EMS patients and 96 self-transport patients with the diagnosis of NSTEMI based on billing code...
March 2016: American Journal of Emergency Medicine
Andrew Fu Wah Ho, Pin Pin Pek, Stephanie Fook-Chong, Ting Hway Wong, Yih Yng Ng, Aaron Sung Lung Wong, Marcus Eng Hock Ong
BACKGROUND: Timely reperfusion in ST-segment elevation myocardial infarction (STEMI) improves outcomes. System delay is that between first medical contact and reperfusion therapy, comprising prehospital and hospital components. This study aimed to characterize prehospital system delay in Singapore. METHODS: A retrospective chart review was performed for 462 consecutive STEMI patients presenting to a tertiary hospital from December 2006 to April 2008. Patients with cardiac arrest secondarily presented were excluded...
2015: World Journal of Emergency Medicine
Marco Campo Dell' Orto, Christian Hamm, Christoph Liebetrau, Dorothea Hempel, Reinhold Merbs, Colleen Cuca, Raoul Breitkreutz
OBJECTIVES: ECG is an essential diagnostic tool in patients with acute coronary syndrome. We aimed to determine how many patients presenting with atypical symptoms for an acute myocardial infarction show ST-segment elevations on prehospital ECG. We also aimed to study the feasibility of telemetric-assisted prehospital ECG analysis. PATIENTS AND METHODS: Between April 2010 and February 2011, consecutive emergency patients presenting with atypical symptoms such as nausea, vomiting, atypical chest pain, palpitations, hypertension, syncope, or dizziness were included in the study...
December 1, 2015: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
Clotilde Bailleul, Etienne Puymirat, Nadia Aissaoui, François Schiele, Gregory Ducrocq, Pierre Coste, Didier Blanchard, Camille Brasselet, Meyer Elbaz, Philippe Gabriel Steg, Hervé Le Breton, Eric Bonnefoy-Cudraz, Gilles Montalescot, Yves Cottin, Patrick Goldstein, Jean Ferrières, Tabassome Simon, Nicolas Danchin
Early infarct-related artery (IRA) patency is associated with better clinical outcomes in patients with ST-elevation myocardial infarction (STEMI). Using the French Registry of ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) 2010 registry, we investigated factors related to IRA patency (thrombolysis in myocardial infarction [TIMI] 2/3 flow) at the start of procedure in patients admitted for primary percutaneous coronary intervention. FAST-MI 2010 is a nationwide French registry including 4,169 patients with acute MI...
January 1, 2016: American Journal of Cardiology
S Azzaz, C Charbonnel, B Ajlani, G Cherif, R Convers, E Blicq, S Augusto, G Gibault-Genty, N Baron, M Koukabi, S Almeida, A Vienet-Legué, S Da Costa, G Galuscan, J Schwob, B Livarek, J-L Georges
BACKGROUND: In patients with acute ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI), the recommended times (first medical contact-to-balloon (M2B) <120 or <90min, and door-to-balloon (D2B) <45min) are reached in less than 50% of patients. PURPOSE: To compare the interventional reperfusion strategy and reperfusion times between two series of consecutive STEMI patients referred for pPCI within 12hours of symptom onset, in 2007 and 2012...
November 2015: Annales de Cardiologie et D'angéiologie
Michael McCaul, Andrit Lourens, Tamara Kredo
No abstract text is available yet for this article.
December 2015: Heart: Official Journal of the British Cardiac Society
Ju Yeon Heo, Ki Jeong Hong, Sang Do Shin, Kyoung Jun Song, Young Sun Ro
STUDY OBJECTIVE: Rapid access to reperfusion is important in ST-segment elevation myocardial infarction (STEMI). The goal of this study is to assess the association of the educational level of patients with STEMI and prehospital and inhospital delay before reperfusion. METHODS: We used a nationwide database of 31 emergency departments for cardiovascular disease surveillance operated by the Korean Centers for Disease Control and Prevention. ST-segment elevation myocardial infarction cases registered from November 2007 to December 2012 were enrolled...
December 2015: American Journal of Emergency Medicine
Salah S Al-Zaiti, Christian Martin-Gill, Ervin Sejdić, Mohammad Alrawashdeh, Clifton Callaway
BACKGROUND: The serum rise of cardiac troponin remains the gold standard for diagnosing non-ST elevation (NSTE) myocardial infarction (MI) despite its delayed response. Novel methods for real-time detection of NSTEMI would result in more immediate initiation of definitive medical therapy and faster transport to facilities that can provide specialized cardiac care. METHODS: EMPIRE is an ongoing prospective, observational cohort study designed to quantify the magnitude of ischemia-induced repolarization dispersion for the early detection of NSTEMI...
November 2015: Journal of Electrocardiology
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