PMID- 29951310
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220318
IS  - 2090-8016 (Print)
IS  - 2090-0597 (Electronic)
IS  - 2090-0597 (Linking)
VI  - 2018
DP  - 2018
TI  - Keys to Achieving Target First Medical Contact to Balloon Times and Bypassing 
      Emergency Department More Important Than Distance.
PG  - 2951860
LID - 10.1155/2018/2951860 [doi]
LID - 2951860
AB  - BACKGROUND: Australian guidelines advocate primary percutaneous coronary 
      intervention (PPCI) as the reperfusion strategy of choice for ST elevation 
      myocardial infarction (STEMI) in patients in whom it can be performed within 90 
      minutes of first medical contact; otherwise, fibrinolytic therapy is preferred. 
      In a large health district, the reperfusion strategy is often chosen in the 
      prehospital setting. We sought to identify a distance from a PCI centre, which 
      made it unlikely first medical contact to balloon time (FMCTB) of less than 90 
      minutes could be achieved in the Hunter New England health district and to 
      identify causes of delay in patients who were triaged to a PPCI strategy. METHODS 
      AND RESULTS: We studied 116 patients presenting via the ambulance service with 
      STEMI from January 2016 to December 2016. In patients who were taken directly to 
      the cardiac catheterisation lab, a maximum distance of 50 km from hospital 
      resulted in 75% of patients receiving PCI within 90 minutes and approximately 95% 
      of patients receiving PCI within 120 minutes. Patients who bypassed the emergency 
      department (ED) were significantly more likely to have FMCTB of less than 90 
      minutes (p < 0.001) despite having a longer travel distance (28.5 km versus 
      17.4 km, p < 0.001). Patients transiting via the ED were significantly more 
      likely to present out of hours (60 versus 24.2% p < 0.001). CONCLUSIONS: Patients 
      who do not bypass the ED have a longer FMCTB across all spectrum of distances 
      from the PCI centre; therefore, bypassing the ED is key to achieving target FMCTB 
      times. Using a cutoff distance of 50 km may reduce human error in estimating 
      travel time to our PCI centre and thereby identifying patients who should receive 
      prehospital thrombolysis.
FAU - Ezad, Saad
AU  - Ezad S
AUID- ORCID: 0000-0002-3008-5290
AD  - John Hunter Hospital, Hunter New England Health, Newcastle, NSW, Australia.
FAU - Davies, Allan J
AU  - Davies AJ
AUID- ORCID: 0000-0002-5929-3472
AD  - John Hunter Hospital, Hunter New England Health, Newcastle, NSW, Australia.
FAU - Cheema, Hooria
AU  - Cheema H
AD  - John Hunter Hospital, Hunter New England Health, Newcastle, NSW, Australia.
FAU - Williams, Trent
AU  - Williams T
AD  - John Hunter Hospital, Hunter New England Health, Newcastle, NSW, Australia.
FAU - Leitch, James
AU  - Leitch J
AD  - John Hunter Hospital, Hunter New England Health, Newcastle, NSW, Australia.
LA  - eng
PT  - Journal Article
DEP - 20180521
PL  - United States
TA  - Cardiol Res Pract
JT  - Cardiology research and practice
JID - 101516542
PMC - PMC5987289
EDAT- 2018/06/29 06:00
MHDA- 2018/06/29 06:01
PMCR- 2018/05/21
CRDT- 2018/06/29 06:00
PHST- 2018/01/11 00:00 [received]
PHST- 2018/03/27 00:00 [revised]
PHST- 2018/04/30 00:00 [accepted]
PHST- 2018/06/29 06:00 [entrez]
PHST- 2018/06/29 06:00 [pubmed]
PHST- 2018/06/29 06:01 [medline]
PHST- 2018/05/21 00:00 [pmc-release]
AID - 10.1155/2018/2951860 [doi]
PST - epublish
SO  - Cardiol Res Pract. 2018 May 21;2018:2951860. doi: 10.1155/2018/2951860. 
      eCollection 2018.