Shorter Door-to-ECG Time Is Associated with Improved Mortality in STEMI Patients.
Maame Yaa A B YiadomWu GongSean M BloosGabrielle BunneyRana KabeerMelissa A PasaoFatima RodriguezChristopher W BaughAngela M MillsNicholas GavinSeth R PodolskyGilberto A SalazarBrian PattersonBryn Elissa MummaMary E TanskiDandan LiuPublished in: Journal of clinical medicine (2024)
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.
Keyphrases
- st segment elevation myocardial infarction
- ejection fraction
- percutaneous coronary intervention
- st elevation myocardial infarction
- end stage renal disease
- cardiovascular events
- aortic stenosis
- newly diagnosed
- chronic kidney disease
- left ventricular
- emergency department
- risk factors
- acute myocardial infarction
- heart rate variability
- acute coronary syndrome
- coronary artery disease
- prognostic factors
- healthcare
- randomized controlled trial
- cardiovascular disease
- oxidative stress
- stem cells
- clinical trial
- palliative care
- bone marrow
- heart failure
- mesenchymal stem cells
- atrial fibrillation
- quality improvement
- cardiac resynchronization therapy