Shorter Door-to-ECG Time Is Associated with Improved Mortality in STEMI Patients

Author:

Yiadom Maame Yaa A. B.1ORCID,Gong Wu2,Bloos Sean M.3,Bunney Gabrielle1,Kabeer Rana1,Pasao Melissa A.1,Rodriguez Fatima4,Baugh Christopher W.5ORCID,Mills Angela M.6,Gavin Nicholas7ORCID,Podolsky Seth R.8,Salazar Gilberto A.9ORCID,Patterson Brian10,Mumma Bryn E.11ORCID,Tanski Mary E.12,Liu Dandan2

Affiliation:

1. Department of Emergency Medicine, Stanford University, 900 Welch Road, Ste 350, Palo Alto, CA 94304, USA

2. Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 1100, Nashville, TN 37203, USA

3. Tulane University School of Medicine, 1430 Tulane Ave., New Orleans, LA 70112, USA

4. Division of Cardiovascular Medicine, Department of Medicine, Stanford University, 6453 Quarry Rd., Palo Alto, CA 94304, USA

5. Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard University, 75 Francis Street, Boston, MA 02115, USA

6. Department of Emergency Medicine, Columbia University College of Physicians and Surgeons, 622 W 168th St., New York, NY 10032, USA

7. Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1468 Madison Ave., New York, NY 10029, USA

8. Department of Dean Administration, Oregon Health & Sciences University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA

9. Department of Emergency Medicine Parkland Hospital, University of Texas Southwestern Medical Center—Dallas, 5323 Harry Hines Boulevard E4.300, Dallas, TX 75390, USA

10. Department of Emergency Medicine, University of Wisconsin—Madison, 800 University Bay Dr Suite 310, Madison, WI 53705, USA

11. Department of Emergency Medicine, University of California at Davis, 2245 45th St., Sacramento, CA 95817, USA

12. Department of Emergency Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA

Abstract

Background: Delayed intervention for ST-segment elevation myocardial infarction (STEMI) is associated with higher mortality. The association of door-to-ECG (D2E) with clinical outcomes has not been directly explored in a contemporary US-based population. Methods: This was a three-year, 10-center, retrospective cohort study of ED-diagnosed patients with STEMI comparing mortality between those who received timely (<10 min) vs. untimely (>10 min) diagnostic ECG. Among survivors, we explored left ventricular ejection fraction (LVEF) dysfunction during the STEMI encounter and recovery upon post-discharge follow-up. Results: Mortality was lower among those who received a timely ECG where one-week mortality was 5% (21/420) vs. 10.2% (26/256) among those with untimely ECGs (p = 0.016), and in-hospital mortality was 6.0% (25/420) vs. 10.9% (28/256) (p = 0.028). Data to compare change in LVEF metrics were available in only 24% of patients during the STEMI encounter and 46.5% on discharge follow-up. Conclusions: D2E within 10 min may be associated with a 50% reduction in mortality among ED STEMI patients. LVEF dysfunction is the primary resultant morbidity among STEMI survivors but was infrequently assessed despite low LVEF being an indication for survival-improving therapy. It will be difficult to assess the impact of STEMI care interventions without more consistent LVEF assessment.

Funder

National Institutes of Health’s (NIH) National Center for Advancing Translational Sciences

National Heart Lung and Blood Institute

Stanford Department of Emergency Medicine

Publisher

MDPI AG

Reference33 articles.

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