PMID- 26881815
OWN - NLM
STAT- MEDLINE
DCOM- 20161213
LR  - 20221207
IS  - 1535-2811 (Electronic)
IS  - 1535-2811 (Linking)
VI  - 15
IP  - 1
DP  - 2016 Mar
TI  - Characteristics of ST Elevation Myocardial Infarction Patients Who Do Not Undergo 
      Percutaneous Coronary Intervention After Prehospital Cardiac Catheterization 
      Laboratory Activation.
PG  - 16-21
LID - 10.1097/HPC.0000000000000069 [doi]
AB  - OBJECTIVES: To assess the clinical and electrocardiographic characteristics of 
      patients diagnosed with ST elevation myocardial infarction (STEMI) that are 
      associated with an increased likelihood of not undergoing percutaneous coronary 
      intervention (PCI) after prehospital Cardiac Catheterization Laboratory 
      activation in a regional STEMI system. METHODS: We performed a retrospective 
      analysis of prehospital Cardiac Catheterization Laboratory activations in 
      Mecklenburg County, North Carolina, between May 2008 and March 2011. Data were 
      extracted from the prehospital patient record, the prehospital electrocardiogram, 
      and the regional STEMI database. The independent variables of interest included 
      objective patient characteristics as well as documented cardiac history and risk 
      factors. Analysis was performed using descriptive statistics and logistic 
      regression. RESULTS: Two hundred thirty-one prehospital activations were included 
      in the analysis. Five independent variables were found to be associated with an 
      increased likelihood of not undergoing PCI: increasing age, bundle branch block, 
      elevated heart rate, left ventricular hypertrophy, and non-white race. The 
      variables with the most significance were any type of bundle branch block 
      [adjusted odds ratios (AOR), 5.66; 95% confidence interval (CI), 1.91-16.76], 
      left ventricular hypertrophy (AOR, 4.63; 95% CI, 2.03-10.53), and non-white race 
      (AOR, 3.53; 95% CI, 1.76-7.08). Conversely, the only variable associated with a 
      higher likelihood of undergoing PCI was the presence of arm pain (AOR, 2.94; 95% 
      CI, 1.36-6.25). CONCLUSIONS: Several of the above variables are expected 
      electrocardiogram mimics; however, the decreased rate of PCI in non-white 
      patients highlights an area for investigation and process improvement. This may 
      guide the development of prehospital STEMI protocols, although avoiding false 
      positive and inappropriate activations.
FAU - Musey, Paul I Jr
AU  - Musey PI Jr
AD  - From the *Department of Emergency Medicine, Indiana University School of 
      Medicine, Indianapolis, IN; daggerMecklenburg Emergency Medical Services Agency, 
      Charlotte, NC; and double daggerDepartment of Emergency Medicine, Carolinas Medical Center, 
      Charlotte, NC.
FAU - Studnek, Jonathan R
AU  - Studnek JR
FAU - Garvey, Lee
AU  - Garvey L
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Crit Pathw Cardiol
JT  - Critical pathways in cardiology
JID - 101165286
SB  - IM
MH  - Black or African American
MH  - Age Factors
MH  - Aged
MH  - Bundle-Branch Block/epidemiology
MH  - Cardiac Catheterization
MH  - *Cardiology Service, Hospital
MH  - Comorbidity
MH  - Electrocardiography
MH  - *Emergency Medical Services
MH  - Female
MH  - Humans
MH  - Hypertrophy, Left Ventricular/epidemiology
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/epidemiology/physiopathology/*surgery
MH  - North Carolina
MH  - Odds Ratio
MH  - Percutaneous Coronary Intervention/*statistics & numerical data
MH  - Retrospective Studies
MH  - Tachycardia/epidemiology
MH  - White People
EDAT- 2016/02/18 06:00
MHDA- 2016/12/15 06:00
CRDT- 2016/02/17 06:00
PHST- 2016/02/17 06:00 [entrez]
PHST- 2016/02/18 06:00 [pubmed]
PHST- 2016/12/15 06:00 [medline]
AID - 00132577-201603000-00004 [pii]
AID - 10.1097/HPC.0000000000000069 [doi]
PST - ppublish
SO  - Crit Pathw Cardiol. 2016 Mar;15(1):16-21. doi: 10.1097/HPC.0000000000000069.