PMID- 24393257 OWN - NLM STAT- MEDLINE DCOM- 20140421 LR - 20191210 IS - 1879-1913 (Electronic) IS - 0002-9149 (Linking) VI - 113 IP - 5 DP - 2014 Mar 1 TI - Predictors of reperfusion delay in patients with ST elevation myocardial infarction self-transported to the hospital (from the American Heart Association's Mission: Lifeline Program). PG - 798-802 LID - S0002-9149(13)02381-3 [pii] LID - 10.1016/j.amjcard.2013.11.036 [doi] AB - Primary percutaneous coronary intervention for ST elevation myocardial infarction (STEMI) is beneficial if performed in a timely manner. Self-transport patients with STEMI have prolonged treatment times compared with Emergency Medical Services-transported patients. This study evaluated self-transport patients with STEMI undergoing primary percutaneous coronary intervention to identify factors associated with prolonged door-to-balloon (D2B) times. From January 2007 to March 2011, data for 13,379 self-transport patients with STEMI treated at 432 hospitals in the Acute Coronary Treatment Intervention Outcomes Network Registry-Get With The Guidelines Registry were evaluated. Patients with a D2B time >90 minutes were compared with those with D2B time 90 minutes) were explored using logistic generalized estimating equations. The median (twenty-fifth, seventy-fifth percentiles) D2B time for the entire cohort was 72 minutes (58, 86), and 19% had a D2B time of >90 minutes. Over the study period, there was a significant increase in the percentage of patients achieving D2B time 90 minutes. The main factors associated with prolonged treatment time were off-hour presentation (weekends and 7 p.m. to 7 a.m. weekdays), not obtaining an electrocardiogram within 10 minutes of hospital arrival, previous coronary artery bypass surgery, black race, older age, and female gender. In conclusion, although prolonged delay from arrival to electrocardiographic acquisition is a modifiable factor contributing to prolonged D2B times among self-transport patients with STEMI, additional factors (age, race, and gender) indicate that historic disparities for cardiovascular care still persist in terms of contemporary metrics for STEMI reperfusion. CI - Copyright (c) 2014 Elsevier Inc. All rights reserved. FAU - Shavelle, David M AU - Shavelle DM AD - Division of Cardiovascular Medicine, University of Southern California, Los Angeles, California. Electronic address: shavelle@usc.edu. FAU - Chen, Anita Y AU - Chen AY AD - Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina. FAU - Matthews, Ray V AU - Matthews RV AD - Division of Cardiovascular Medicine, University of Southern California, Los Angeles, California. FAU - Roe, Matthew T AU - Roe MT AD - Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina. FAU - de Lemos, James A AU - de Lemos JA AD - Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas. FAU - Jollis, James AU - Jollis J AD - Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina. FAU - Thomas, Joseph L AU - Thomas JL AD - Division of Cardiology, Harbor UCLA Medical Center, Torrance, California. FAU - French, William J AU - French WJ AD - Division of Cardiology, Harbor UCLA Medical Center, Torrance, California. CN - ACTION-GWTG Investigators LA - eng PT - Journal Article DEP - 20131212 PL - United States TA - Am J Cardiol JT - The American journal of cardiology JID - 0207277 SB - IM MH - After-Hours Care MH - Aged MH - Emergency Medical Services MH - Female MH - Humans MH - Male MH - Middle Aged MH - Myocardial Infarction/*therapy MH - Myocardial Reperfusion/*standards MH - Percutaneous Coronary Intervention/*standards MH - *Process Assessment, Health Care MH - Risk Factors MH - Time Factors MH - *Time-to-Treatment/standards MH - *Transportation of Patients EDAT- 2014/01/08 06:00 MHDA- 2014/04/22 06:00 CRDT- 2014/01/08 06:00 PHST- 2013/10/19 00:00 [received] PHST- 2013/11/18 00:00 [revised] PHST- 2013/11/18 00:00 [accepted] PHST- 2014/01/08 06:00 [entrez] PHST- 2014/01/08 06:00 [pubmed] PHST- 2014/04/22 06:00 [medline] AID - S0002-9149(13)02381-3 [pii] AID - 10.1016/j.amjcard.2013.11.036 [doi] PST - ppublish SO - Am J Cardiol. 2014 Mar 1;113(5):798-802. doi: 10.1016/j.amjcard.2013.11.036. Epub 2013 Dec 12.