Author + information
- Received May 3, 2018
- Revision received July 12, 2018
- Accepted July 17, 2018
- Published online September 17, 2018.
- Jay S. Shavadia, MDa,b,∗ (, )
- Matthew T. Roe, MD, MHSa,
- Anita Y. Chen, MSa,
- Joseph Lucas, PhDa,
- Alexander C. Fanaroff, MDa,
- Ajar Kochar, MDa,
- Christopher B. Fordyce, MD, MHSc,
- James G. Jollis, MDa,d,
- Jacqueline Tamis-Holland, MDe,
- Timothy D. Henry, MDf,
- Akshay Bagai, MD, MHSg,
- Michael C. Kontos, MDh,
- Christopher B. Granger, MDa and
- Tracy Y. Wang, MD, MHS, MSca
- aDuke Clinical Research Institute, Durham, North Carolina
- bUniversity of Alberta, Edmonton, Alberta, Canada
- cDivision of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
- dUniversity of North Carolina, Chapel Hill, North Carolina
- eMount Sinai Saint Luke’s Hospital, New York, New York
- fCedars-Sinai Heart Institute, Los Angeles, California
- gTerrence Donnelly Heart Center, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
- hPauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
- ↵∗Address for correspondence:
Dr. Jay S. Shavadia, Duke Clinical Research Institute, 2400 Pratt Street, Room 7035, Durham, North Carolina 27705.
Objectives The aim of this study was to describe the prevalence of pre-hospital cardiac catheterization laboratory activation and its association with reperfusion timeliness and in-hospital mortality.
Background For patients with ST-segment elevation myocardial infarction diagnosed in the field, catheterization laboratory pre-activation may lead to more timely reperfusion and improved outcomes.
Methods A total of 27,840 patients with ST-segment elevation myocardial infarction transported via emergency medical services to 744 percutaneous coronary intervention–capable hospitals in the ACTION Registry from January 2015 to March 2017 were evaluated, excluding patients with cardiac arrest or requiring pre–percutaneous coronary intervention intubation. Catheterization laboratory pre-activation was defined as activation >10 min prior to hospital arrival.
Results Catheterization laboratory pre-activation occurred in 41% of patients (n = 11,379), with minor presenting differences between those with and without catheterization laboratory pre-activation. Compared with no catheterization laboratory pre-activation, pre-activation patients were more likely to be directly transported to the catheterization laboratory on hospital arrival (23.3% vs. 5.3%), to have shorter hospital arrival–to–catheterization laboratory arrival time (median 17 min [interquartile range (IQR): 7 to 25 min] vs. 28 min [IQR: 18 to 39 min]), to have shorter door-to-device time (40 min [IQR: 30 to 51 min] vs. 52 min [IQR: 41 to 65 min]), and to have a greater likelihood of achieving first medical contact–to–device time ≤90 min (76.6% vs. 68.6%) (p < 0.001 for all). Pre-activation was associated with lower in-hospital mortality (2.8% vs. 3.4%; p = 0.01). Patients treated at hospitals in the lowest tertile of pre-activation rates had higher mortality than those treated at hospitals in the highest tertile before and after adjustment (3.6% vs. 2.7%; adjusted odds ratio: 1.33; 95% confidence interval: 1.08 to 1.63).
Conclusions In the United States, catheterization laboratory pre-activation occurred in fewer than one-half of emergency medical services–transported patients with ST-segment elevation myocardial infarction. Its association with faster reperfusion and lower mortality supports greater use of this strategy.
- pre-hospital cardiac catheterization laboratory activation
- primary percutaneous coronary intervention
- ST-segment elevation myocardial infarction
Dr. Fordyce is a consultant and advisory board member for Bayer, Novo Nordisk, and Boehringer Ingelheim. Dr. Granger has received research grants from The Medicines Company and AstraZeneca; and is a consultant for Bristol-Myers Squibb, Daiichi-Sankyo Bayer, The Medicines Company, AstraZeneca, and Janssen. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 3, 2018.
- Revision received July 12, 2018.
- Accepted July 17, 2018.
- 2018 American College of Cardiology Foundation