Impact of the Type of First Medical Contact within a Guideline-Conform ST-Elevation Myocardial Infarction Network: A Prospective Observational Registry Study
The impact of type of first medical contact (FMC) in the setting of a guideline conform metropolitan ST-elevation myocardial infarction (STEMI) network providing obligatory primary percutaneous coronary intervention (PCI) is unclear. 3,312 patients were prospectively included between 2006 and 2012 i...
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| Veröffentlicht in: | PloS one 2016-06, Vol.11 (6), p.e0156769-e0156769 |
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| creator | Pfister, Roman Lee, Samuel Kuhr, Kathrin Baer, Frank Fehske, Wolfgang Hoepp, Hans-Wilhelm Baldus, Stephan Michels, Guido |
| description | The impact of type of first medical contact (FMC) in the setting of a guideline conform metropolitan ST-elevation myocardial infarction (STEMI) network providing obligatory primary percutaneous coronary intervention (PCI) is unclear.
3,312 patients were prospectively included between 2006 and 2012 into a registry accompanying the "Cologne Infarction Model" STEMI network, with 68.4% primarily presenting to emergency medical service (EMS), 17.6% to non-PCI-capable hospitals, and 14.0% to PCI-capable hospitals. Median contact-to-balloon time differed significantly by FMC with 89 minutes (IQR 72-115) for EMS, 107 minutes (IQR 85-148) for non-PCI- and 65 minutes (IQR 48-91) for PCI-capable hospitals (p < 0.001). TIMI-flow grade III and in-hospital mortality were 75.7% and 10.4% in EMS, 70.3% and 8.6% in non-PCI capable hospital and 84.4% and 5.6% in PCI-capable hospital presenters, respectively (p both < 0.01). The association of FMC with in-hospital mortality was not significant after adjustment for baseline characteristics, but risk of TIMI-flow grade < III remained significantly increased in patients presenting to non-PCI capable hospitals.
Despite differences in treatment delay by type of FMC in-hospital mortality did not differ significantly. The increased risk of TIMI-flow grade < III in patients presenting to non PCI-capable hospitals needs further study. |
| doi_str_mv | 10.1371/journal.pone.0156769 |
| format | Article |
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3,312 patients were prospectively included between 2006 and 2012 into a registry accompanying the "Cologne Infarction Model" STEMI network, with 68.4% primarily presenting to emergency medical service (EMS), 17.6% to non-PCI-capable hospitals, and 14.0% to PCI-capable hospitals. Median contact-to-balloon time differed significantly by FMC with 89 minutes (IQR 72-115) for EMS, 107 minutes (IQR 85-148) for non-PCI- and 65 minutes (IQR 48-91) for PCI-capable hospitals (p < 0.001). TIMI-flow grade III and in-hospital mortality were 75.7% and 10.4% in EMS, 70.3% and 8.6% in non-PCI capable hospital and 84.4% and 5.6% in PCI-capable hospital presenters, respectively (p both < 0.01). The association of FMC with in-hospital mortality was not significant after adjustment for baseline characteristics, but risk of TIMI-flow grade < III remained significantly increased in patients presenting to non-PCI capable hospitals.
Despite differences in treatment delay by type of FMC in-hospital mortality did not differ significantly. The increased risk of TIMI-flow grade < III in patients presenting to non PCI-capable hospitals needs further study.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0156769</identifier><identifier>PMID: 27258655</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Aged ; Analysis ; Balloon angioplasty ; Balloon treatment ; Biology and Life Sciences ; Care and treatment ; Cologne ; Coronary Angiography ; Diagnosis ; Electrocardiography ; Emergency medical services ; Female ; Germany ; Health aspects ; Health services ; Heart attack ; Heart Rate - physiology ; Hospital Mortality ; Hospitals ; Humans ; Logistic Models ; Male ; Medicine and Health Sciences ; Middle Aged ; Models, Theoretical ; Mortality ; Myocardial infarction ; Patient outcomes ; Patients ; People and Places ; Percutaneous Coronary Intervention ; Practice guidelines (Medicine) ; Prospective Studies ; Registries ; Research and Analysis Methods ; Risk factors ; ST Elevation Myocardial Infarction ; Time Factors</subject><ispartof>PloS one, 2016-06, Vol.11 (6), p.e0156769-e0156769</ispartof><rights>COPYRIGHT 2016 Public Library of Science</rights><rights>2016 Pfister et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2016 Pfister et al 2016 Pfister et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c725t-4a28dc5aadacff48d16ee63a93fe74f0eafd226b1038c42f16bec8de8014cd403</citedby><cites>FETCH-LOGICAL-c725t-4a28dc5aadacff48d16ee63a93fe74f0eafd226b1038c42f16bec8de8014cd403</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4892676/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4892676/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27258655$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Merx, Marc W.</contributor><creatorcontrib>Pfister, Roman</creatorcontrib><creatorcontrib>Lee, Samuel</creatorcontrib><creatorcontrib>Kuhr, Kathrin</creatorcontrib><creatorcontrib>Baer, Frank</creatorcontrib><creatorcontrib>Fehske, Wolfgang</creatorcontrib><creatorcontrib>Hoepp, Hans-Wilhelm</creatorcontrib><creatorcontrib>Baldus, Stephan</creatorcontrib><creatorcontrib>Michels, Guido</creatorcontrib><title>Impact of the Type of First Medical Contact within a Guideline-Conform ST-Elevation Myocardial Infarction Network: A Prospective Observational Registry Study</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>The impact of type of first medical contact (FMC) in the setting of a guideline conform metropolitan ST-elevation myocardial infarction (STEMI) network providing obligatory primary percutaneous coronary intervention (PCI) is unclear.
3,312 patients were prospectively included between 2006 and 2012 into a registry accompanying the "Cologne Infarction Model" STEMI network, with 68.4% primarily presenting to emergency medical service (EMS), 17.6% to non-PCI-capable hospitals, and 14.0% to PCI-capable hospitals. Median contact-to-balloon time differed significantly by FMC with 89 minutes (IQR 72-115) for EMS, 107 minutes (IQR 85-148) for non-PCI- and 65 minutes (IQR 48-91) for PCI-capable hospitals (p < 0.001). TIMI-flow grade III and in-hospital mortality were 75.7% and 10.4% in EMS, 70.3% and 8.6% in non-PCI capable hospital and 84.4% and 5.6% in PCI-capable hospital presenters, respectively (p both < 0.01). The association of FMC with in-hospital mortality was not significant after adjustment for baseline characteristics, but risk of TIMI-flow grade < III remained significantly increased in patients presenting to non-PCI capable hospitals.
Despite differences in treatment delay by type of FMC in-hospital mortality did not differ significantly. The increased risk of TIMI-flow grade < III in patients presenting to non PCI-capable hospitals needs further study.</description><subject>Aged</subject><subject>Analysis</subject><subject>Balloon angioplasty</subject><subject>Balloon treatment</subject><subject>Biology and Life Sciences</subject><subject>Care and treatment</subject><subject>Cologne</subject><subject>Coronary Angiography</subject><subject>Diagnosis</subject><subject>Electrocardiography</subject><subject>Emergency medical services</subject><subject>Female</subject><subject>Germany</subject><subject>Health aspects</subject><subject>Health services</subject><subject>Heart attack</subject><subject>Heart Rate - physiology</subject><subject>Hospital Mortality</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Models, 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Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pfister, Roman</au><au>Lee, Samuel</au><au>Kuhr, Kathrin</au><au>Baer, Frank</au><au>Fehske, Wolfgang</au><au>Hoepp, Hans-Wilhelm</au><au>Baldus, Stephan</au><au>Michels, Guido</au><au>Merx, Marc W.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of the Type of First Medical Contact within a Guideline-Conform ST-Elevation Myocardial Infarction Network: A Prospective Observational Registry Study</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2016-06-03</date><risdate>2016</risdate><volume>11</volume><issue>6</issue><spage>e0156769</spage><epage>e0156769</epage><pages>e0156769-e0156769</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>The impact of type of first medical contact (FMC) in the setting of a guideline conform metropolitan ST-elevation myocardial infarction (STEMI) network providing obligatory primary percutaneous coronary intervention (PCI) is unclear.
3,312 patients were prospectively included between 2006 and 2012 into a registry accompanying the "Cologne Infarction Model" STEMI network, with 68.4% primarily presenting to emergency medical service (EMS), 17.6% to non-PCI-capable hospitals, and 14.0% to PCI-capable hospitals. Median contact-to-balloon time differed significantly by FMC with 89 minutes (IQR 72-115) for EMS, 107 minutes (IQR 85-148) for non-PCI- and 65 minutes (IQR 48-91) for PCI-capable hospitals (p < 0.001). TIMI-flow grade III and in-hospital mortality were 75.7% and 10.4% in EMS, 70.3% and 8.6% in non-PCI capable hospital and 84.4% and 5.6% in PCI-capable hospital presenters, respectively (p both < 0.01). The association of FMC with in-hospital mortality was not significant after adjustment for baseline characteristics, but risk of TIMI-flow grade < III remained significantly increased in patients presenting to non-PCI capable hospitals.
Despite differences in treatment delay by type of FMC in-hospital mortality did not differ significantly. The increased risk of TIMI-flow grade < III in patients presenting to non PCI-capable hospitals needs further study.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>27258655</pmid><doi>10.1371/journal.pone.0156769</doi><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Aged Analysis Balloon angioplasty Balloon treatment Biology and Life Sciences Care and treatment Cologne Coronary Angiography Diagnosis Electrocardiography Emergency medical services Female Germany Health aspects Health services Heart attack Heart Rate - physiology Hospital Mortality Hospitals Humans Logistic Models Male Medicine and Health Sciences Middle Aged Models, Theoretical Mortality Myocardial infarction Patient outcomes Patients People and Places Percutaneous Coronary Intervention Practice guidelines (Medicine) Prospective Studies Registries Research and Analysis Methods Risk factors ST Elevation Myocardial Infarction Time Factors |
| title | Impact of the Type of First Medical Contact within a Guideline-Conform ST-Elevation Myocardial Infarction Network: A Prospective Observational Registry Study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-24T05%3A45%3A21IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Impact%20of%20the%20Type%20of%20First%20Medical%20Contact%20within%20a%20Guideline-Conform%20ST-Elevation%20Myocardial%20Infarction%20Network:%20A%20Prospective%20Observational%20Registry%20Study&rft.jtitle=PloS%20one&rft.au=Pfister,%20Roman&rft.date=2016-06-03&rft.volume=11&rft.issue=6&rft.spage=e0156769&rft.epage=e0156769&rft.pages=e0156769-e0156769&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0156769&rft_dat=%3Cgale_plos_%3EA454205564%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1793753307&rft_id=info:pmid/27258655&rft_galeid=A454205564&rft_doaj_id=oai_doaj_org_article_13e485cff9834c3f8188ffa15b50b018&rfr_iscdi=true |