Annals of Emergency Medicine
Volume 53, Issue 2 , Pages 233-240.e5 , February 2009

Direct Paramedic Transport of Acute Myocardial Infarction Patients to Percutaneous Coronary Intervention Centers: A Decision Analysis

Presented at the Society for Medical Decision Making annual meeting, October 2007, Pittsburgh, PA; and the National Association of EMS Physicians annual meeting, January 2008, Phoenix, AZ.

  • Henry E. Wang, MD, MS

      Affiliations

    • Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA
    • Corresponding Author InformationAddress for correspondence: Henry E. Wang, MD, MS, Department of Emergency Medicine, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL 35249-7013; 205-975-7387
  • ,
  • Oscar C. Marroquin, MD

      Affiliations

    • Cardiovascular Institute, University of Pittsburgh, Pittsburgh, PA
  • ,
  • Kenneth J. Smith, MD, MS

      Affiliations

    • Section of Decision Sciences, Department of Medicine, University of Pittsburgh, Pittsburgh, PA

Received 27 February 2008 ,Revised 13 June 2008 ,Accepted 17 July 2008.

References 

  1. Ting HH, Yang EH, Rihal CS. Narrative review: reperfusion strategies for ST-segment elevation myocardial infarction. Ann Intern Med. 2006;145:610–617
  2. Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). J Am Coll Cardiol. 2004;44:E1–E211
  3. So DY, Ha AC, Turek MA, et al. Comparison of mortality patterns in patients with ST-elevation myocardial infarction arriving by emergency medical services versus self-transport (from the prospective Ottawa Hospital STEMI Registry). Am J Cardiol. 2006;97:458–461
  4. Gershlick AH, Stephens-Lloyd A, Hughes S, et al. Rescue angioplasty after failed thrombolytic therapy for acute myocardial infarction. N Engl J Med. 2005;353:2758–2768
  5. Brodie BR. Facilitated percutaneous coronary intervention. Heart. 2005;91:1527–1529
  6. Le May MR, Davies RF, Dionne R, et al. Comparison of early mortality of paramedic-diagnosed ST-segment elevation myocardial infarction with immediate transport to a designated primary percutaneous coronary intervention center to that of similar patients transported to the nearest hospital. Am J Cardiol. 2006;98:1329–1333
  7. Evenson KR, Schroeder EB, Legare TB, et al. A comparison of emergency medical services times for stroke and myocardial infarction. Prehosp Emerg Care. 2001;5:335–339
  8. Rittenberger JC, Beck PW, Paris PM. Errors of omission in the treatment of prehospital chest pain patients. Prehosp Emerg Care. 2005;9:2–7
  9. Nallamothu BK, Bates ER, Wang Y, et al. Driving times and distances to hospitals with percutaneous coronary intervention in the United States: implications for prehospital triage of patients with ST-elevation myocardial infarction. Circulation. 2006;113:1189–1195
  10. Bradley EH, Herrin J, Wang Y, et al. Strategies for reducing the door-to-balloon time in acute myocardial infarction. N Engl J Med. 2006;355:2308–2320
  11. Brodie BR, Stone GW, Cox DA, et al. Impact of treatment delays on outcomes of primary percutaneous coronary intervention for acute myocardial infarction: analysis from the CADILLAC Trial. Am Heart J. 2006;151:1231–1238
  12. Curtis JP, Portnay EL, Wang Y, et al. The pre-hospital electrocardiogram and time to reperfusion in patients with acute myocardial infarction, 2000-2002: findings from the National Registry of Myocardial Infarction-4. J Am Coll Cardiol. 2006;47:1544–1552
  13. Huynh T, O'Loughlin J, Joseph L, et al. Delays to reperfusion therapy in acute ST-segment elevation myocardial infarction: results from the AMI-QUEBEC Study. CMAJ. 2006;175:1527–1532
  14. McNamara RL, Wang Y, Herrin J, et al. Effect of door-to-balloon time on mortality in patients with ST-segment elevation myocardial infarction. J Am Coll Cardiol. 2006;47:2180–2186
  15. Pinto DS, Kirtane AJ, Nallamothu BK, et al. Hospital delays in reperfusion for ST-elevation myocardial infarction: implications when selecting a reperfusion strategy. Circulation. 2006;114:2019–2025
  16. Ryan JW, Peterson ED, Chen AY, et al. Optimal timing of intervention in non-ST-segment elevation acute coronary syndromes: insights from the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines) Registry. Circulation. 2005;112:3049–3057
  17. Swor R, Hegerberg S, McHugh-McNally A, et al. Prehospital 12-lead ECG: efficacy or effectiveness?. Prehosp Emerg Care. 2006;10:374–377
  18. Vaught C, Young DR, Bell SJ, et al. The failure of years of experience with electrocardiographic transmission from paramedics to the hospital emergency department to reduce the delay from door to primary coronary intervention below the 90-minute threshold during acute myocardial infarction. J Electrocardiol. 2006;39:136–141
  19. Boersma E. Does time matter? (a pooled analysis of randomized clinical trials comparing primary percutaneous coronary intervention and in-hospital fibrinolysis in acute myocardial infarction patients). Eur Heart J. 2006;27:779–788
  20. Steg PG, Bonnefoy E, Chabaud S, et al. Impact of time to treatment on mortality after prehospital fibrinolysis or primary angioplasty: data from the CAPTIM randomized clinical trial. Circulation. 2003;108:2851–2856
  21. Doubilet P, Begg CB, Weinstein MC, et al. Probabilistic sensitivity analysis using Monte Carlo simulation (A practical approach). Med Decis Making. 1985;5:157–177
  22. Claxton K, Sculpher M, McCabe C, et al. Probabilistic sensitivity analysis for NICE technology assessment: not an optional extra. Health economics. 2005;14:339–347
  23. Hartwell D, Colquitt J, Loveman E, et al. Clinical effectiveness and cost-effectiveness of immediate angioplasty for acute myocardial infarction: systematic review and economic evaluation. Health Technol Assess. 2005;9:1–99iii-iv
  24. Garvey JL, MacLeod BA, Sopko G, et al. Pre-hospital 12-lead electrocardiography programs: a call for implementation by emergency medical services systems providing advanced life support—National Heart Attack Alert Program (NHAAP) Coordinating Committee; National Heart, Lung, and Blood Institute (NHLBI); National Institutes of Health. J Am Coll Cardiol. 2006;47:485–491
  25. Morrison LJ, Brooks S, Sawadsky B, et al. Prehospital 12-lead electrocardiography impact on acute myocardial infarction treatment times and mortality: a systematic review. Acad Emerg Med. 2006;13:84–89
  26. Brainard AH, Raynovich W, Tandberg D, et al. The prehospital 12-lead electrocardiogram's effect on time to initiation of reperfusion therapy: a systematic review and meta-analysis of existing literature. Am J Emerg Med. 2005;23:351–356
  27. Widimsky P, Budesinsky T, Vorac D, et al. Long distance transport for primary angioplasty vs immediate thrombolysis in acute myocardial infarction (Final results of the randomized national multicentre trial—PRAGUE-2). Eur Heart J. 2003;24:94–104
  28. Ioannidis JP. Why most published research findings are false. PLoS Med. 2005;2:e124

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Dr. Wang is supported by Clinical Research Development Award K08-HS013628 from the Agency for Healthcare Research and Quality, Rockville, MD.

 Earn CME Credit: Continuing Medical Education is available for this article at: www.ACEP-EMedHome.com.

 Supervising editor: Kathy J. Rinnert, MD, MPH

 Author contributions: HEW conceived the study. HEW, OCM, and KJS designed the analysis. HEW carried out the analysis. All authors contributed substantially to the writing and editing of the article. HEW takes responsibility for the paper as a whole.

 Reprints not available from the authors.

 Publication date: Available online September 18, 2008.

PII: S0196-0644(08)01508-4

doi: 10.1016/j.annemergmed.2008.07.020

Annals of Emergency Medicine
Volume 53, Issue 2 , Pages 233-240.e5 , February 2009