Causes of Delay and Associated Mortality in Patients Transferred With ST-Segment―Elevation Myocardial Infarction
Regional ST-segment-elevation myocardial infarction systems are being developed to improve timely access to primary percutaneous coronary intervention (PCI). System delays may diminish the mortality benefit achieved with primary PCI in ST-segment-elevation myocardial infarction patients, but the spe...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2011-10, Vol.124 (15), p.1636-1644 |
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| creator | MIEDEMA, Michael D NEWELL, Marc C DUVAL, Sue GARBERICH, Ross F HANDRAN, Chauncy B LARSON, David M MULDER, Steven WANG, Yale L LIPS, Daniel L HENRY, Timothy D |
| description | Regional ST-segment-elevation myocardial infarction systems are being developed to improve timely access to primary percutaneous coronary intervention (PCI). System delays may diminish the mortality benefit achieved with primary PCI in ST-segment-elevation myocardial infarction patients, but the specific reasons for and clinical impact of delays in patients transferred for PCI are unknown.
This was a prospective, observational study of 2034 patients transferred for primary PCI at a single center as part of a regional ST-segment-elevation myocardial infarction system from March 2003 to December 2009. Despite long-distance transfers, 30.4% of patients (n=613) were treated in ≤ 90 minutes and 65.7% (n=1324) were treated in ≤ 120 minutes. Delays occurred most frequently at the referral hospital (64.0%, n=1298), followed by the PCI center (15.7%, n=317) and transport (12.6%, n=255). For the referral hospital, the most common reasons for delay were awaiting transport (26.4%, n=535) and emergency department delays (14.3%, n=289). Diagnostic dilemmas (median, 95.5 minutes; 25th and 75th percentiles, 72-127 minutes) and nondiagnostic initial ECGs (81 minutes; 64-110.5 minutes) led to delays of the greatest magnitude. Delays caused by cardiac arrest and/or cardiogenic shock had the highest in-hospital mortality (30.6%), in contrast with nondiagnostic initial ECGs, which, despite long treatment delays, did not affect mortality (0%). Significant variation in both the magnitude and clinical impact of delays also occurred during the transport and PCI center segments.
Treatment delays occur even in efficient systems for ST-segment-elevation myocardial infarction care. The clinical impact of specific delays in interhospital transfer for PCI varies according to the cause of the delay. |
| doi_str_mv | 10.1161/CIRCULATIONAHA.111.033118 |
| format | Article |
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This was a prospective, observational study of 2034 patients transferred for primary PCI at a single center as part of a regional ST-segment-elevation myocardial infarction system from March 2003 to December 2009. Despite long-distance transfers, 30.4% of patients (n=613) were treated in ≤ 90 minutes and 65.7% (n=1324) were treated in ≤ 120 minutes. Delays occurred most frequently at the referral hospital (64.0%, n=1298), followed by the PCI center (15.7%, n=317) and transport (12.6%, n=255). For the referral hospital, the most common reasons for delay were awaiting transport (26.4%, n=535) and emergency department delays (14.3%, n=289). Diagnostic dilemmas (median, 95.5 minutes; 25th and 75th percentiles, 72-127 minutes) and nondiagnostic initial ECGs (81 minutes; 64-110.5 minutes) led to delays of the greatest magnitude. Delays caused by cardiac arrest and/or cardiogenic shock had the highest in-hospital mortality (30.6%), in contrast with nondiagnostic initial ECGs, which, despite long treatment delays, did not affect mortality (0%). Significant variation in both the magnitude and clinical impact of delays also occurred during the transport and PCI center segments.
Treatment delays occur even in efficient systems for ST-segment-elevation myocardial infarction care. The clinical impact of specific delays in interhospital transfer for PCI varies according to the cause of the delay.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/CIRCULATIONAHA.111.033118</identifier><identifier>PMID: 21931079</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Aged ; Angioplasty, Balloon, Coronary ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology. Vascular system ; Delivery of Health Care ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Electrocardiography ; Female ; Humans ; Male ; Medical sciences ; Middle Aged ; Myocardial Infarction - mortality ; Myocardial Infarction - physiopathology ; Myocardial Infarction - therapy ; Patient Transfer ; Prospective Studies ; Referral and Consultation ; Time Factors</subject><ispartof>Circulation (New York, N.Y.), 2011-10, Vol.124 (15), p.1636-1644</ispartof><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c397t-c6d2298603c427a799fb2621ff79359083f4111913583821e01fe5bfa68c95293</citedby><cites>FETCH-LOGICAL-c397t-c6d2298603c427a799fb2621ff79359083f4111913583821e01fe5bfa68c95293</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3674,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24612666$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21931079$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>MIEDEMA, Michael D</creatorcontrib><creatorcontrib>NEWELL, Marc C</creatorcontrib><creatorcontrib>DUVAL, Sue</creatorcontrib><creatorcontrib>GARBERICH, Ross F</creatorcontrib><creatorcontrib>HANDRAN, Chauncy B</creatorcontrib><creatorcontrib>LARSON, David M</creatorcontrib><creatorcontrib>MULDER, Steven</creatorcontrib><creatorcontrib>WANG, Yale L</creatorcontrib><creatorcontrib>LIPS, Daniel L</creatorcontrib><creatorcontrib>HENRY, Timothy D</creatorcontrib><title>Causes of Delay and Associated Mortality in Patients Transferred With ST-Segment―Elevation Myocardial Infarction</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>Regional ST-segment-elevation myocardial infarction systems are being developed to improve timely access to primary percutaneous coronary intervention (PCI). System delays may diminish the mortality benefit achieved with primary PCI in ST-segment-elevation myocardial infarction patients, but the specific reasons for and clinical impact of delays in patients transferred for PCI are unknown.
This was a prospective, observational study of 2034 patients transferred for primary PCI at a single center as part of a regional ST-segment-elevation myocardial infarction system from March 2003 to December 2009. Despite long-distance transfers, 30.4% of patients (n=613) were treated in ≤ 90 minutes and 65.7% (n=1324) were treated in ≤ 120 minutes. Delays occurred most frequently at the referral hospital (64.0%, n=1298), followed by the PCI center (15.7%, n=317) and transport (12.6%, n=255). For the referral hospital, the most common reasons for delay were awaiting transport (26.4%, n=535) and emergency department delays (14.3%, n=289). Diagnostic dilemmas (median, 95.5 minutes; 25th and 75th percentiles, 72-127 minutes) and nondiagnostic initial ECGs (81 minutes; 64-110.5 minutes) led to delays of the greatest magnitude. Delays caused by cardiac arrest and/or cardiogenic shock had the highest in-hospital mortality (30.6%), in contrast with nondiagnostic initial ECGs, which, despite long treatment delays, did not affect mortality (0%). Significant variation in both the magnitude and clinical impact of delays also occurred during the transport and PCI center segments.
Treatment delays occur even in efficient systems for ST-segment-elevation myocardial infarction care. The clinical impact of specific delays in interhospital transfer for PCI varies according to the cause of the delay.</description><subject>Aged</subject><subject>Angioplasty, Balloon, Coronary</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiology. Vascular system</subject><subject>Delivery of Health Care</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - mortality</subject><subject>Myocardial Infarction - physiopathology</subject><subject>Myocardial Infarction - therapy</subject><subject>Patient Transfer</subject><subject>Prospective Studies</subject><subject>Referral and Consultation</subject><subject>Time Factors</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkMtu1DAUhq0KRKeFV6jMArFK8bETX5ZR6GWkKa3aqVhGZxwbjDJJsTNIs-tL9AX7JLiaAcTK8u_v99H5CHkP7BRAwqdmftvcL-rl_PpLfVnnDE6ZEAD6gMyg4mVRVsK8IjPGmCmU4PyQHKX0I1-lUNUbcsjBCGDKzEhscJNcoqOnn12PW4pDR-uURhtwch29GuOEfZi2NAz0BqfghinRZcQheRdjJr6G6Tu9WxZ37ts6Pz4_Pp317lcmx4FebUeLsQvY0_ngMdqX9C157bFP7t3-PCb352fL5rJYXF_Mm3pRWGHUVFjZcW60ZMKWXKEyxq-45OC9MqIyTAtf5s0NiEoLzcEx8K5aeZTamoobcUw-7v59iOPPjUtTuw7Jur7HwY2b1GqjNAgtVCbNjrRxTCk63z7EsMa4bYG1L8bb_43nDNqd8dw92U_ZrNau-9v8ozgDH_YAJou9z-psSP-4UgKXUorfsSaLsw</recordid><startdate>20111011</startdate><enddate>20111011</enddate><creator>MIEDEMA, Michael D</creator><creator>NEWELL, Marc C</creator><creator>DUVAL, Sue</creator><creator>GARBERICH, Ross F</creator><creator>HANDRAN, Chauncy B</creator><creator>LARSON, David M</creator><creator>MULDER, Steven</creator><creator>WANG, Yale L</creator><creator>LIPS, Daniel L</creator><creator>HENRY, Timothy D</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20111011</creationdate><title>Causes of Delay and Associated Mortality in Patients Transferred With ST-Segment―Elevation Myocardial Infarction</title><author>MIEDEMA, Michael D ; NEWELL, Marc C ; DUVAL, Sue ; GARBERICH, Ross F ; HANDRAN, Chauncy B ; LARSON, David M ; MULDER, Steven ; WANG, Yale L ; LIPS, Daniel L ; HENRY, Timothy D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c397t-c6d2298603c427a799fb2621ff79359083f4111913583821e01fe5bfa68c95293</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Aged</topic><topic>Angioplasty, Balloon, Coronary</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiology. Vascular system</topic><topic>Delivery of Health Care</topic><topic>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - mortality</topic><topic>Myocardial Infarction - physiopathology</topic><topic>Myocardial Infarction - therapy</topic><topic>Patient Transfer</topic><topic>Prospective Studies</topic><topic>Referral and Consultation</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>MIEDEMA, Michael D</creatorcontrib><creatorcontrib>NEWELL, Marc C</creatorcontrib><creatorcontrib>DUVAL, Sue</creatorcontrib><creatorcontrib>GARBERICH, Ross F</creatorcontrib><creatorcontrib>HANDRAN, Chauncy B</creatorcontrib><creatorcontrib>LARSON, David M</creatorcontrib><creatorcontrib>MULDER, Steven</creatorcontrib><creatorcontrib>WANG, Yale L</creatorcontrib><creatorcontrib>LIPS, Daniel L</creatorcontrib><creatorcontrib>HENRY, Timothy D</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>MIEDEMA, Michael D</au><au>NEWELL, Marc C</au><au>DUVAL, Sue</au><au>GARBERICH, Ross F</au><au>HANDRAN, Chauncy B</au><au>LARSON, David M</au><au>MULDER, Steven</au><au>WANG, Yale L</au><au>LIPS, Daniel L</au><au>HENRY, Timothy D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Causes of Delay and Associated Mortality in Patients Transferred With ST-Segment―Elevation Myocardial Infarction</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2011-10-11</date><risdate>2011</risdate><volume>124</volume><issue>15</issue><spage>1636</spage><epage>1644</epage><pages>1636-1644</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>Regional ST-segment-elevation myocardial infarction systems are being developed to improve timely access to primary percutaneous coronary intervention (PCI). System delays may diminish the mortality benefit achieved with primary PCI in ST-segment-elevation myocardial infarction patients, but the specific reasons for and clinical impact of delays in patients transferred for PCI are unknown.
This was a prospective, observational study of 2034 patients transferred for primary PCI at a single center as part of a regional ST-segment-elevation myocardial infarction system from March 2003 to December 2009. Despite long-distance transfers, 30.4% of patients (n=613) were treated in ≤ 90 minutes and 65.7% (n=1324) were treated in ≤ 120 minutes. Delays occurred most frequently at the referral hospital (64.0%, n=1298), followed by the PCI center (15.7%, n=317) and transport (12.6%, n=255). For the referral hospital, the most common reasons for delay were awaiting transport (26.4%, n=535) and emergency department delays (14.3%, n=289). Diagnostic dilemmas (median, 95.5 minutes; 25th and 75th percentiles, 72-127 minutes) and nondiagnostic initial ECGs (81 minutes; 64-110.5 minutes) led to delays of the greatest magnitude. Delays caused by cardiac arrest and/or cardiogenic shock had the highest in-hospital mortality (30.6%), in contrast with nondiagnostic initial ECGs, which, despite long treatment delays, did not affect mortality (0%). Significant variation in both the magnitude and clinical impact of delays also occurred during the transport and PCI center segments.
Treatment delays occur even in efficient systems for ST-segment-elevation myocardial infarction care. The clinical impact of specific delays in interhospital transfer for PCI varies according to the cause of the delay.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>21931079</pmid><doi>10.1161/CIRCULATIONAHA.111.033118</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| source | Journals@Ovid Ovid Autoload; MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Aged Angioplasty, Balloon, Coronary Biological and medical sciences Blood and lymphatic vessels Cardiology. Vascular system Delivery of Health Care Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Electrocardiography Female Humans Male Medical sciences Middle Aged Myocardial Infarction - mortality Myocardial Infarction - physiopathology Myocardial Infarction - therapy Patient Transfer Prospective Studies Referral and Consultation Time Factors |
| title | Causes of Delay and Associated Mortality in Patients Transferred With ST-Segment―Elevation Myocardial Infarction |
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