PMID- 24578769
OWN - NLM
STAT- MEDLINE
DCOM- 20151026
LR  - 20211021
IS  - 1936-900X (Print)
IS  - 1936-9018 (Electronic)
IS  - 1936-900X (Linking)
VI  - 15
IP  - 1
DP  - 2014 Feb
TI  - Importance of hospital entry: walk-in STEMI and primary percutaneous coronary 
      intervention.
PG  - 81-7
LID - 10.5811/westjem.2013.9.17855 [doi]
AB  - INTRODUCTION: Patients with ST elevation myocardial infarction (STEMI) require 
      rapid identification and triage to initiate reperfusion therapy. Walk-in STEMI 
      patients have longer treatment times compared to emergency medical service (EMS) 
      transported patients. While effective triage of large numbers of critically ill 
      patients in the emergency department is often cited as the reason for treatment 
      delays, additional factors have not been explored. The purpose of this study was 
      to evaluate baseline demographic and clinical differences between walk-in and 
      EMS-transported STEMI patients and identify factors associated with prolonged 
      door to balloon (D2B) time in walk-in STEMI patients. METHODS: We performed a 
      retrospective review of 136 STEMI patients presenting to an urban academic 
      teaching center from January 2009 through December 2010. Baseline demographics, 
      mode of hospital entry (walk-in versus EMS transport), treatment times, 
      angiographic findings, procedures performed and in-hospital clinical events were 
      collected. We compared walk-in and EMS-transported STEMI patients and identified 
      independent factors of prolonged D2B time for walk-in patients using stepwise 
      logistic regression analysis. RESULTS: Walk-in patients (n=51) were more likely 
      to be Latino and presented with a higher heart rate, higher systolic blood 
      pressure, prior history of diabetes mellitus and were more likely to have an 
      elevated initial troponin value, compared to EMS-transported patients. 
      EMS-transported patients (n=64) were more likely to be white and had a higher 
      prevalence of left main coronary artery disease, compared to walk-in patients. 
      Door to electrocardiogram (ECG), ECG to catheterization laboratory (CL) 
      activation and D2B times were significantly longer for walk-in patients. Walk-in 
      patients were more likely to have D2B time >90 minutes, compared to EMS- 
      transported patients; odds ratio 3.53 (95% CI 1.03, 12.07), p=0.04. Stepwise 
      logistic regression identified hospital entry mode as the only independent 
      predictor for prolonged D2B time. CONCLUSION: Baseline differences exist between 
      walk-in and EMS-transported STEMI patients undergoing primary percutaneous 
      coronary intervention (PCI). Hospital entry mode was the most important predictor 
      for prolonged treatment times for primary PCI, independent of age, Latino 
      ethnicity, heart rate, systolic blood pressure and initial troponin value. 
      Prolonged door to ECG and ECG to CL activation times are modifiable factors 
      associated with prolonged treatment times in walk-in STEMI patients. In addition 
      to promoting the use of EMS transport, efforts are needed to rapidly identify and 
      expedite the triage of walk-in STEMI patients.
FAU - Bansal, Eric
AU  - Bansal E
AD  - Division of Cardiovascular Medicine, University of Southern California, Los 
      Angeles, California.
FAU - Dhawan, Rahul
AU  - Dhawan R
AD  - Division of Cardiovascular Medicine, University of Southern California, Los 
      Angeles, California.
FAU - Wagman, Brittany
AU  - Wagman B
AD  - Office of Biostatistics and Outcomes Assessment, Los Angeles County + University 
      of Southern California Medical Center, Los Angeles, California.
FAU - Low, Garren
AU  - Low G
AD  - Office of Biostatistics and Outcomes Assessment, Los Angeles County + University 
      of Southern California Medical Center, Los Angeles, California.
FAU - Zheng, Ling
AU  - Zheng L
AD  - Department of Neurology, University of Southern California, Los Angeles, 
      California.
FAU - Chan, Linda
AU  - Chan L
AD  - Office of Biostatistics and Outcomes Assessment, Los Angeles County + University 
      of Southern California Medical Center, Los Angeles, California.
FAU - Newton, Kim
AU  - Newton K
AD  - Department of Emergency Medicine, University of Southern California, Los Angeles, 
      California.
FAU - Swadron, Stuart P
AU  - Swadron SP
AD  - Department of Emergency Medicine, University of Southern California, Los Angeles, 
      California.
FAU - Testa, Nicholas
AU  - Testa N
AD  - Department of Emergency Medicine, University of Southern California, Los Angeles, 
      California.
FAU - Shavelle, David M
AU  - Shavelle DM
AD  - Division of Cardiovascular Medicine, University of Southern California, Los 
      Angeles, California.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - West J Emerg Med
JT  - The western journal of emergency medicine
JID - 101476450
SB  - IM
MH  - Ambulances/statistics & numerical data
MH  - Cardiac Catheterization/statistics & numerical data
MH  - Electrocardiography/statistics & numerical data
MH  - Emergency Service, Hospital/statistics & numerical data
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/diagnosis/*surgery
MH  - Percutaneous Coronary Intervention/*statistics & numerical data
MH  - Time Factors
PMC - PMC3935790
EDAT- 2014/03/01 06:00
MHDA- 2014/03/01 06:01
PMCR- 2014/02/01
CRDT- 2014/03/01 06:00
PHST- 2013/04/01 00:00 [received]
PHST- 2013/07/09 00:00 [revised]
PHST- 2013/09/04 00:00 [accepted]
PHST- 2014/03/01 06:00 [entrez]
PHST- 2014/03/01 06:00 [pubmed]
PHST- 2014/03/01 06:01 [medline]
PHST- 2014/02/01 00:00 [pmc-release]
AID - wjem-15-81 [pii]
AID - 10.5811/westjem.2013.9.17855 [doi]
PST - ppublish
SO  - West J Emerg Med. 2014 Feb;15(1):81-7. doi: 10.5811/westjem.2013.9.17855.