Can WeChat group-based intervention reduce reperfusion time in patients with ST-segment myocardial infarction? A controlled before and after study

2019 ◽  
Vol 26 (10) ◽  
pp. 627-637
Author(s):  
Hui Liu ◽  
Wei Wang ◽  
Haojia Chen ◽  
Zhi Li ◽  
Shushuang Feng ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Control Group ◽  
Catheterization Laboratory ◽  
Percutaneous Coronary ◽  
Before And After ◽  
St Elevation ◽  
Before And After Study

Background Pre-hospital identification of acute ST-elevation myocardial infarction and activation of the catheterization laboratory can reduce first medical contact to wire-crossing times. We conducted a study on providing 24-hour tele-electrocardiography services via the WeChat group application, aiming to reduce the time taken for diagnosis and treatment of ST-elevation myocardial infarction. Methods A controlled before and after study was conducted on 140 ST-elevation myocardial infarction patients who were initially seen in non-percutaneous coronary intervention-capable hospital and transferred for primary percutaneous coronary intervention at our percutaneous coronary intervention centre from 1 February to 31 October 2018. The WeChat group had 70 patients with pre-hospital electrocardiography transmission via WeChat and the control group had 70 patients who did not transfer pre-hospital electrocardiography. The reperfusion time of the two groups was compared to evaluate the effect of the WeChat group intervention. Results In the WeChat group versus the control group, the median symptom onset to first medical contact time was similar (129 vs 150 min, p > 0.05), but the median first medical contact to wire, door to wire and first medical contact to catheterization laboratory activity were significantly shorter (132 vs 171 minutes, p < 0.001; 60 vs 95 minutes, p < 0.001; 29 vs 74 minutes, p < 0.001, respectively). Conclusions Pre-hospital electrocardiography transfer via a WeChat group resulted in earlier reperfusion of ST-elevation myocardial infarction patients who were transferred from the non-percutaneous coronary intervention centre.

scholarly journals The effects of prearrival direct notification call to interventional cardiologist on door-to-balloon time in patients who required secondary diversion with ST-elevation myocardial infarction for primary percutaneous coronary intervention

2018 ◽  
Vol 26 (3) ◽  
pp. 165-173
Author(s):  
Jeong Cheon Choe ◽  
Kwang Soo Cha ◽  
Jin Hee Choi ◽  
Jinhee Ahn ◽  
Jin Hee Kim ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Hospital Mortality ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Catheterization Laboratory ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Door To Balloon

Background: Rapid door-to-balloon times in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention are associated with favorable outcomes. Objectives: We evaluated the effects of prearrival direct notification calls to interventional cardiologists on door-to-balloon time for ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Methods: A 24-h hotline was created to allow prearrival direct notification calls to interventional cardiologists when transferring ST-elevation myocardial infarction patients. In an urban, tertiary referral center, patients who visited via inter-facility or the emergency department directly were included. Clinical parameters, time to reperfusion therapy, and in-hospital mortality were compared between patients with and without prearrival notifications. Results: Of 228 ST-elevation myocardial infarction patients, 95 (41.7%) were transferred with prearrival notifications. In these patients, door-to-balloon time was shorter (50.0 vs 60.0 min, p = 0.010) and the proportion of patients with door-to-balloon time < 90 min was higher (89.5% vs 75.9%, p = 0.034) than patients without notifications. These improvements were more pronounced during “off-duty” hours (52.0 vs 78.0 min, p = 0.001; 88.3% vs 72.3%, p = 0.047, respectively) than during “on-duty” hours (37.5 vs 43.5 min, p = 0.164; 94.4% vs 79.4%, p = 0.274, respectively). In addition, door-to-activation time (–39 vs 11 min, p < 0.001) and door-to-catheterization laboratory arrival time (33 vs 42 min, p = 0.007) were shorter in patients with prearrival notifications than those without. However, in-hospital mortality was similar between the two groups (6.3% vs 6.8%, p = 0.892). Conclusion: Prearrival direct notification calls to interventional cardiologists significantly improved the door-to-balloon time and the proportion of patients with door-to-balloon time < 90 min through rapid patient transport in primary percutaneous coronary intervention scheduled hospital and readiness of the catheterization laboratory.

scholarly journals Prehospital triage and direct transport of patients with ST-elevation myocardial infarction to primary percutaneous coronary intervention centres: a systematic review and meta-analysis

CJEM ◽  
2009 ◽  
Vol 11 (05) ◽  
pp. 481-492 ◽  
Author(s):  
Steven C. Brooks ◽  
Katherine S. Allan ◽  
Michelle Welsford ◽  
P. Richard Verbeek ◽  
Hans-Richard Arntz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Control Group ◽  
Primary Pci ◽  
Care Providers ◽  
Percutaneous Coronary ◽  
All Cause Mortality ◽  
St Elevation

ABSTRACT Objective: Percutaneous coronary intervention (PCI) appears to be superior to in-hospital fibrinolysis for most patients with ST-elevation myocardial infarction (STEMI). However, few hospitals have PCI capability. The optimal prehospital strategy for facilitating rapid coronary reperfusion in STEMI patients is unclear. We sought to determine whether direct transport of adult STEMI patients by emergency medical services to primary PCI centres improves 30-day all-cause mortality when compared with a strategy of transportation to the closest hospital. Methods: We systematically searched MEDLINE, EMBASE, Cochrane “CENTRAL” database (1980-July 2007) and several other electronic databases. Two authors independently assessed citations for relevance. Two authors independently abstracted data from included studies. We included studies that, 1) transported patients directly to a PCI-capable centre for primary PCI, 2) had a control group that was transported to the closest hospital and 3) reported outcomes of treatment time intervals, all-cause mortality, reinfarction rate, stroke rate or the frequency of cardiogenic shock. We used a random effects model to provide pooled estimates of relative risk (RR) when data allowed. Results: We identified 2264 citations with the search. Five studies, including 980 STEMI patients, met inclusion criteria, and were clinically heterogeneous and of variable quality. Most studies were European (3/5) and involved physician out-of-hospital care providers. There was a trend toward increased survival with direct transport to primary PCI but this was not statistically significant (RR 0.51, 95% confidence interval [CI] 0.24–1.10). One study reported nonsignificant reductions in reinfarction (RR 0.43, 95% CI 0.11–1.60) and stroke (RR 0.33, 95% CI 0.01–8.06) with direct transport for primary PCI. Conclusion: There is insufficient evidence to support the effectiveness of direct transport of patients with STEMI for primary PCI when compared with transportation to the closest hospital.

scholarly journals (A80) Nationwide Study to Improve Door-to-Balloon Times in Patients with Acute St Elevation Myocardial Infarction Requiring Primary Percutaneous Coronary Intervention Using Prehospital ECG Transmission

2011 ◽  
Vol 26 (S1) ◽  
pp. s22-s22
Author(s):  
M.E. Ong ◽  
A.S. Wong ◽  
S.G. Teo ◽  
C.M. Seet ◽  
B.L. Lim ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Ambulance Service ◽  
St Elevation Myocardial Infarction ◽  
Percutaneous Coronary ◽  
Before And After ◽  
St Elevation ◽  
Door To Balloon

ObjectiveTo reduce nationwide door-to-balloon times (DTB) in patients presenting with acute ST-elevation myocardial infarction (STEMI) requiring primary percutaneous coronary intervention (PCI), by adoption of pre-hospital wireless 12-lead electrocardiogram (ECG) transmission by Singapore's national ambulance service.MethodsA phased, prospective, before-after, interventional study of all patients who presented to the national ambulance service with the diagnosis of STEMI. In the ‘Before’ phase, chest pain patients only received 12-lead ECGs on arrival at the Emergency Departments (ED), where diagnosis of STEMI could be made. In the ‘After’ phase, 12-lead ECGs were performed in the field by ambulance crews and transmitted while en-route to the hospitals. Diagnoses of STEMI was made by on-duty emergency physicians (EP) prior to patients' arrival and PCI activated. Data was collected from ambulance run sheets, ECG transmission logs, EDs and cardiology units.Results451 eligible patients from “Before” and 214 patients from “After” phase were included in the analysis. Median DTB time was 88 minutes in the “Before” and 52 minutes in the “After” phase (p = 0.0001). During office hours, median DTB times for ‘Before’ and ‘After’ phases were 84 minutes and 47 minutes, respectively (p = 0.0001). After office hours, median DTB times for ‘Before’ and ‘After’ phases were 95 minutes and 54 minutes, respectively (p = 0.0001). There were 11 false positive activations in “Before” phase and one in the “After” phase.ConclusionPre-hospital ECG transmission resulted in significant reduction of DTB time; this effect occurred regardless of whether patients presented to the ED before or after office hours. No increase in false activations was found in the “After” phase. Pre-hospital ECG transmission should be adopted as “standard of care” for all STEMI cases meeting the criteria for PCI.

Mortality of patients admitted to hospital with acute ST-elevation myocardial infarction, before and after the opening of primary percutaneous coronary intervention unit in Szombathely

2009 ◽  
Vol 150 (43) ◽  
pp. 1973-1977 ◽  
Author(s):  
Lajos Nagy ◽  
Judit Novák ◽  
Dénes Csonka
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Percutaneous Coronary ◽  
Before And After ◽  
St Elevation ◽  
Intervention Unit

Az akut szívizominfarktus kezelési stratégiája alapvetően megváltozott az elmúlt időszakban. Továbbra is vita tárgya a két reperfúziós stratégia, a primer percutan coronariaintervenció és a fibrinolízis összehasonlítása. Ha primer percutan coronariaintervenció elérhető, akkor ez a választandó kezelési stratégia ST-szegment-elevációval járó myocardialis infarctusban. Cél: Jelen cikkben a Szombathely városból ST-szegment-elevációval járó akut szívinfarktussal kórházba került betegek 3 hónapos halálozását vizsgáltuk. Módszer: Két időszakot hasonlítottunk össze, 2005-öt, amikor nem volt helyben percutan coronariaintervencióra alkalmas szívkatéteres laboratórium és 2008-at, amikor helyben rendelkezésre állt a primer percutan coronariaintervenció. Eredmények: A 12 órás ischaemiás időszaknál rövidebb betegcsoportban a 3 hónapos halálozás 2008-ban lényegesen alacsonyabb volt a 2005-ös évhez képest (3,6% versus 15,6%). Elsősorban a fibrinolízissel kezelt betegcsoport magas, három hónapos mortalitása volt felelős a különbségért. Ugyancsak fontos, hogy 2008-ban csökkent a 12 órán túli betegek aránya 2005-höz képest. Következtetés: A szívkatéteres labor létrehozása kedvező hatással volt Szombathely város ST-elevációs infarktusos betegeinek kórlefolyására.

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