PMID- 21435313
OWN - NLM
STAT- MEDLINE
DCOM- 20110719
LR  - 20220318
IS  - 1481-8043 (Electronic)
IS  - 1481-8035 (Linking)
VI  - 13
IP  - 2
DP  - 2011 Mar
TI  - Effect of time to electrocardiogram on time from electrocardiogram to 
      fibrinolysis in acute myocardial infarction patients.
PG  - 79-89
AB  - OBJECTIVE: The American Heart Association (AHA) recommends a benchmark 
      door-to-electrocardiogram (ECG) time of 10 minutes for acute myocardial 
      infarction patients, but this is based on expert opinion (level of evidence C). 
      We sought to establish an evidence-based benchmark door-to-ECG time. METHODS: 
      This retrospective cohort study used a population-based sample of patients who 
      suffered an ST elevation myocardial infarction (STEMI) in Ontario between 1999 
      and 2001. Using cubic smoothing splines, we described (1) the relationship 
      between door-to-ECG time and ECG-to-needle time and (2) the proportion of STEMI 
      patients who met the benchmark door-to-needle time of 30 minutes based on their 
      door-to-ECG time. We hypothesized nonlinear relationships and sought to identify 
      an inflection point in the latter curve that would define the most efficient 
      (benefit the greatest number of patients) door-to-ECG time. RESULTS: In 2,961 
      STEMI patients, the median door-to-ECG and ECG-to-needle times were 8.0 and 27.0 
      minutes, respectively. There was a linear increase in ECG-to-needle time as the 
      door-to-ECG time increased, up to approximately 30 minutes, after which the 
      ECG-to-needle time remained constant at 53 minutes. The inflection point in the 
      probability of achieving the benchmark door-to-needle time occurred at 4 minutes, 
      after which it decreased linearly, with every minute of door-to-ECG time 
      decreasing the average probability of achievement by 2.2%. CONCLUSIONS: Hospitals 
      that are not meeting benchmark reperfusion times may improve performance by 
      decreasing door-to-ECG times, even if they are meeting the current AHA benchmark 
      door-to-ECG time. The highest probability of meeting the reperfusion target time 
      for fibrinolytic administration is associated with a door-to-ECG time of 4 
      minutes or less.
FAU - Atzema, Clare L
AU  - Atzema CL
AD  - Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Room G147, 
      Toronto, ON M4N 3M5. clare.atzema@ices.on.ca
FAU - Austin, Peter C
AU  - Austin PC
FAU - Tu, Jack V
AU  - Tu JV
FAU - Schull, Michael J
AU  - Schull MJ
LA  - eng
GR  - Canadian Institutes of Health Research/Canada
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - CJEM
JT  - CJEM
JID - 100893237
SB  - IM
MH  - Aged
MH  - Benchmarking
MH  - Electrocardiography
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/diagnosis/*drug therapy
MH  - Myocardial Reperfusion/*standards
MH  - Ontario
MH  - *Outcome Assessment, Health Care
MH  - Retrospective Studies
MH  - *Thrombolytic Therapy
MH  - Time Factors
MH  - Triage
EDAT- 2011/03/26 06:00
MHDA- 2011/07/20 06:00
CRDT- 2011/03/26 06:00
PHST- 2011/03/26 06:00 [entrez]
PHST- 2011/03/26 06:00 [pubmed]
PHST- 2011/07/20 06:00 [medline]
AID - 10.2310/8000.2011.110261 [doi]
PST - ppublish
SO  - CJEM. 2011 Mar;13(2):79-89. doi: 10.2310/8000.2011.110261.