Skip the Emergency Department to Save Time?

When patients with ST-segment–elevation myocardial infarction bypass the ED, reperfusion occurs more quickly, but the approach is being tried in only about 10% of U.S. patients, mostly during regular work hours.

Do patients with a prehospital electrocardiographic diagnosis of ST-segment–elevation myocardial infarction (STEMI) fare better when they bypass the emergency department (ED) on the way to the cardiac catheterization laboratory for primary percutaneous coronary intervention (PCI)? To find out, researchers analyzed data from 12,581 patients with STEMI in a large U.S. registry who were transported by emergency medical services (EMS) directly to a PCI-capable hospital. Of this cohort, 1316 patients (10.5%) bypassed the ED; the rest did not. This percentage increased from 8.5% in 2008 to 11.5% in 2011; patients were also more likely to bypass the ED during regular work hours than during off-hours (18% vs. 4% of the time).

The median time between…

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI

Leadership Positions in Professional SocietiesHeart Valve Collaboratory (Scientific Committee Member, Chair of the Publications Committee)