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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

Jeptha P. Curtis, MD^_*, Edward L. Portnay, MD^_*, Yongfei Wang, MS^_*, Robert L. McNamara, MD, MHS^_*, Jeph Herrin, PhD^_*, Elizabeth H. Bradley, PhD, David J. Magid, MD^,, Martha E. Blaney, PharmD^||, John G. Canto, MD, MSPH, FACC^¶ and Harlan M. Krumholz, MD, SM, FACC^_*,,#,_**,_*

^_* Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
Division of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut
Clinical Research Unit, Kaiser Permanente, Denver, Colorado
Departments of Emergency Medicine and Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, Colorado
^|| Genentech Inc., South San Francisco, California
^¶ Watson Clinic, Lakeland, Florida and Division of Cardiovascular Diseases, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
^# Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut
^_** Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut

View larger version (43K): [in a new window]   Figure 1 Derivation of study cohorts. AMI = acute myocardial infarction; ECG = electrocardiogram; LBBB = left bundle-branch block; PCI = percutaneous coronary intervention.

View larger version (54K): [in a new window]   Figure 2 (A) Proportion of patients receiving fibrinolytic therapy within 30 min, 31 to 45 min, and >45 min of hospital arrival. (B) Proportion of patients receiving primary angioplasty with a door-to-balloon time of 90 min, 91 to 120 min, and >120 min of hospital arrival. phECG = pre-hospital electrocardiogram.

View larger version (17K): [in a new window]   Figure 3 Door-to-drug time and door-to-balloon time based on timing of pre-hospital electrocardiogram before admission. Door-to-drug time p = 0.63; door-to-balloon time p = 0.03. phECG = pre-hospital electrocardiogram.