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Outcomes of a Provincial Myocardial Infarction Reperfusion Strategy: A Population-Based, Retrospective Cohort Study

Published online by Cambridge University Press:  03 July 2020

Jolene Cook ,
Alix Carter ,
Judah Goldstein Open the ORCID record for Judah Goldstein [Opens in a new window] ,
Andrew Travers ,
Ryan Brown ,
Janel Swain ,
Jan Jensen ,
Kara Matheson ,
Ed Cain  and
Tony Lee
Jolene Cook*
Affiliation:
Emergency Health Services, Halifax, Nova Scotia, Canada Dalhousie University Department of Emergency Medicine, Halifax, Nova Scotia, Canada Dalhousie University Division of EMS, Halifax, Nova Scotia, Canada Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
Alix Carter
Affiliation:
Emergency Health Services, Halifax, Nova Scotia, Canada Dalhousie University Department of Emergency Medicine, Halifax, Nova Scotia, Canada Dalhousie University Division of EMS, Halifax, Nova Scotia, Canada Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
Judah Goldstein
Affiliation:
Emergency Health Services, Halifax, Nova Scotia, Canada Dalhousie University Division of EMS, Halifax, Nova Scotia, Canada
Andrew Travers
Affiliation:
Emergency Health Services, Halifax, Nova Scotia, Canada Dalhousie University Department of Emergency Medicine, Halifax, Nova Scotia, Canada Dalhousie University Division of EMS, Halifax, Nova Scotia, Canada Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
Ryan Brown
Affiliation:
Emergency Health Services, Halifax, Nova Scotia, Canada Dalhousie University Division of EMS, Halifax, Nova Scotia, Canada
Janel Swain
Affiliation:
Emergency Health Services, Halifax, Nova Scotia, Canada
Jan Jensen
Affiliation:
Emergency Health Services, Halifax, Nova Scotia, Canada Dalhousie University Division of EMS, Halifax, Nova Scotia, Canada Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
Kara Matheson
Affiliation:
Nova Scotia Health Authority Research Methods Unit, Halifax, Nova Scotia, Canada
Ed Cain
Affiliation:
Emergency Health Services, Halifax, Nova Scotia, Canada Dalhousie University Department of Emergency Medicine, Halifax, Nova Scotia, Canada Dalhousie University Division of EMS, Halifax, Nova Scotia, Canada Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
Tony Lee
Affiliation:
Nova Scotia Health Authority, Halifax, Nova Scotia, Canada Dalhousie University Division of Cardiology, Halifax, Nova Scotia, Canada
*
Correspondence: Jolene Cook, MD, CCFP-EM, Dalhousie Department of Emergency Medicine, Division of EMS, Halifax Infirmary Room 3021, 1796 Summer Street, Halifax, Nova Scotia, Canada, B3H 2E1, E-mail: [email protected]
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Abstract

Background:

Fibrinolysis is an acceptable treatment for acute ST-segment elevation myocardial infarction (STEMI) when primary percutaneous coronary intervention (PCI) cannot be performed within 120 minutes. The American Heart Association has recommended Emergency Medical Services (EMS) interventions such as prehospital fibrinolysis (PHF), prehospital electrocardiogram (ECG), and hospital bypass direct to PCI center. Nova Scotia, Canada has incorporated these interventions into a unique province-wide approach to STEMI care. A retrospective cohort analysis comparing the primary outcome of 30-day mortality for patients receiving either prehospital or emergency department (ED) fibrinolysis (EDF) to patients transported directly by EMS from community or regional ED for primary PCI was conducted.

Methods:

This retrospective, population-based cohort study included all STEMI patients in Nova Scotia who survived to hospital admission from July 2011 through July 2013. Three provincial databases were used to collect demographic, 30-day mortality, hospital readmission, and rescue PCI data. The results were grouped and compared according to reperfusion strategy received: PHF, EDF, patients brought by ambulance via EMS direct to PCI (EMS to PCI), and ED to PCI (ED to PCI).

Results:

There were 1,071 STEMI patients included with 145 PHF, 606 EDF, 98 EMS to PCI, and 222 ED to PCI. There were no significant differences in 30-day mortality across groups (n, %): PHF 5(3); EDF 36(6); EHS to PCI <5(2); and ED to PCI 10(4); P = .28. There was no significant difference in patients receiving fibrinolysis who underwent rescue PCI.

Conclusions:

Prehospital fibrinolysis incorporated into a province-wide approach to STEMI treatment is feasible with no observed difference in patient 30-day mortality outcomes observed.

Keywords

EMSfibrinolysismyocardial infarctionSTEMI
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 35 , Issue 5 , October 2020 , pp. 528 - 532
Copyright
© World Association for Disaster and Emergency Medicine 2020

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References

Antman, EM. Bypassing the emergency department to improve the process of care for ST-elevation myocardial infarction: necessary but not sufficient. Circulation. 2013;128(4):322–324.Google Scholar
Ibanez, B, James, S, Agewall, S, et al. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2018;39(2):119–177.CrossRefGoogle ScholarPubMed
Morrison, LJ, Verbeek, PR, McDonald, AC, Sawadsky, BV, Cook, DJ. Mortality and prehospital thrombolysis for acute myocardial infarction: a meta-analysis. JAMA. 2000;283(20):2686–2692.CrossRefGoogle ScholarPubMed
McCaul, M, Lourens, A, Kredo, T. Pre-hospital versus in-hospital thrombolysis for ST-elevation myocardial infarction. Cochrane Database Syst Rev. 2014;10;(9):CD010191.Google Scholar
Schull, MJ, Vaillancourt, S, Donovan, L, et al. Underuse of prehospital strategies to reduce time to reperfusion for ST-elevation myocardial infarction patients in 5 Canadian provinces. CJEM. 2009;11(5):473–480.CrossRefGoogle ScholarPubMed
Statistics Canada Census Profile. 2016 Census Nova Scotia and Canada. https://www12.statcan.gc.ca/census-recensement/2016/dp-pd/prof/details/Page.cfm?Lang=E&Geo1=PR&Code1=12&Geo2=&Code2=&Data=Count&SearchText=Nova%20Scotia&SearchType=Begins&SearchPR=01&B1=All&GeoLevel=PR&GeoCode=12. Accessed September 30, 2018.Google Scholar
Jensen, JL, Walker, M, Denike, D, et al. Paramedic myocardial infarction care with fibrinolytics: a process map and hazard analysis. Prehosp Emerg Care. 2013;17(4):429–434.CrossRefGoogle ScholarPubMed
Emergency Health Services (EHS), Nova Scotia Department of Health. Protocol: STEMI - RESTORE 2013. https://novascotia.ca/dhw/ehs/documents/CPG/EHS6228.99.01.01%20RESTORE.pdf. Accessed September 30, 2018.Google Scholar
Keeley, EC, Boura, JA, Grines, CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomized trials. Lancet. 2003;361(9351):13–20.CrossRefGoogle Scholar
Wong, GC, Welsford, M, Ainsworth, C, et al. 2019 Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology guidelines on the acute management of ST-elevation myocardial infarction: focused update on regionalization and reperfusion. Can J Cardiol. 2019;35(2):107–132.CrossRefGoogle Scholar
Roule, V, Ardouin, P, Blanchart, K, et al. Prehospital fibrinolysis versus primary percutaneous coronary intervention in ST-elevation myocardial infarction: a systematic review and meta-analysis of randomized controlled trials. Crit Care. 2016;20(1):359.CrossRefGoogle ScholarPubMed
Westerhout, CM, Bonnefoy, E, Welsh, RC, Steg, PG, Boutitie, F, Armstrong, PW. The influence of time from symptom onset and reperfusion strategy on 1-year survival in ST-elevation myocardial infarction: a pooled analysis of an early fibrinolytic strategy versus primary percutaneous coronary intervention from CAPTIM and WEST. Am Heart J. 2011;161(2):283–290.CrossRefGoogle ScholarPubMed
Le May, MR, Dionne, R, Maloney, J, Poirier, P. The role of paramedics in a primary PCI program for ST-elevation myocardial infarction. Prog Cardiovasc Dis. 2010;53(3):183–187.CrossRefGoogle Scholar
Armstrong, PW, Gershlick, A, Goldstein, P, et al. The Strategic Reperfusion Early After Myocardial Infarction (STREAM) study. Am Heart J. 2010;160(1):30–35.CrossRefGoogle ScholarPubMed
Cantor, WJ, Fitchett, D, Borgundvaag, B, et al. Routine early angioplasty after fibrinolysis for acute myocardial infarction. N Engl J Med. 2009;360(26):2705–2718.CrossRefGoogle ScholarPubMed