Performance of a New ¡°Physician-Less¡± Automated System of Prehospital ST-Segment Elevation Myocardial Infarction Diagnosis and Catheterization Laboratory Activation
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- 作者：Brian J. Potter ; Alexis Matteau ; Samer Mansour ; Richard Essiambre ; Martine Montigny ; Sylvie Savoie ; Fran?ois Gobeil
- 刊名：The American Journal of Cardiology
- 出版年：2013
- 出版时间：15 July, 2013
- 年：2013
- 卷：112
- 期：2
- 页码：156-161
- 全文大小：443 K
文摘
The door-to-balloon times frequently exceed the recommended delay. We therefore evaluated the performance of a novel ¡°physician-less¡± cardiac catheterization laboratory (CCL) activation system relying on the automated electrocardiographic diagnosis alone. From January 2010 to 2012, first responders performed electrocardiograms in the field for all patients with a complaint of chest pain or dyspnea. An automated machine diagnosis of ¡°acute myocardial infarction¡± resulted in immediate CCL activation and direct transfer without human reinterpretation or transmission of the electrocardiogram. Any activation resulting from a nondiagnostic ECG (no ST-segment elevation) was deemed inappropriate and classified as resulting from either human or machine error. Of 155 activations, 136?(88 % ) were electrocardiographically appropriate. Of these, 128 patients had a final diagnosis of ST-segment elevation myocardial infarction. A door-to-balloon time of <90 minutes was achieved in 99 % , the procedural success was high (94 % ), and the overall mortality was low (3 % ). Of the electrocardiographically appropriate activations, 8 (5 % ) were false-positive results. The remaining 19 activations (12 % ) were inappropriate. Compared with the electrocardiographically appropriate activations, those with inappropriate activations had significantly greater rates of hypertension (p?= 0.0070) and known coronary artery disease (p?= 0.0008) and higher presenting heart rates (p <0.0001). The causes for inappropriate activation were approximately evenly split between human and machine error. In conclusion, a combination of prehospital automated ST-segment elevation myocardial infarction diagnosis and ¡°physician-less¡± CCL activation was safe and effective in ensuring target door-to-balloon times in virtually all patients and resulted in an acceptable rate of inappropriate CCL activation.