Christian Thilo1, Andreas Blüthgen, Wolfgang von Scheidt. 1. I. Medizinische Klinik, Klinikum Augsburg, Herzzentrum Augsburg-Schwaben, Stenglinstr. 2, 86156, Augsburg, Germany, christian.thilo@klinikum-augsburg.de.
Abstract
AIMS: The HERA Registry investigates logistics, adherence to standards, time intervals, and mortality in a regional network for primary percutaneous coronary intervention (PPCI) in ST-elevation myocardial infarction (STEMI) in a mixed urban and rural area. METHODS AND RESULTS: We included 826 consecutive patients (pts) within the HERA network with its dedicated PPCI strategy (female n = 243, mean age 64 years, range 25-98 years) with acute STEMI (May 2007 until January 2010). 680 pts (82 %) received PPCI and 45 (5.4 %) acute bypass surgery. Of 512 pts seen by an emergency physician (EP) as first medical contact (FMC) 87 % received on-scene 12-lead ECG. ECG transmission rate to the PPCI center was 29 %. Median FMC-to-balloon time (CBT) was 135 min and door-to-balloon time (DBT) 70 min. With EP FMC DBT was 38 min with direct transfer to cath lab (n = 70), 69 min via ICU (n = 240), and 132 min via ER (n = 91, p < 0.01). Out of 826 pts, 143(17.3 %) presented in cardiogenic shock. In-hospital mortality was 8.8 % (n = 73), 35.7 % for shock pts versus 3.2 % for non-shock pts (p < 0.01). For pts receiving PPCI, in-hospital mortality was 6.2 %, for shock pts (n = 107) 28.0 %, and for non-shock pts (n = 573) 2.1 % (p < 0.01). CONCLUSION: Prehospital management, CBT and DBT compare favourably to data from studies and registries, but do not yet fulfill strict guideline requirements. Real world mortality in non-shock pts is very low. Direct transfer to cath lab reduces DBTs by 49 %. For this crucial improvement, transmission of a 12-lead ECG to the PPCI center is mandatory.
AIMS: The HERA Registry investigates logistics, adherence to standards, time intervals, and mortality in a regional network for primary percutaneous coronary intervention (PPCI) in ST-elevation myocardial infarction (STEMI) in a mixed urban and rural area. METHODS AND RESULTS: We included 826 consecutive patients (pts) within the HERA network with its dedicated PPCI strategy (female n = 243, mean age 64 years, range 25-98 years) with acute STEMI (May 2007 until January 2010). 680 pts (82 %) received PPCI and 45 (5.4 %) acute bypass surgery. Of 512 pts seen by an emergency physician (EP) as first medical contact (FMC) 87 % received on-scene 12-lead ECG. ECG transmission rate to the PPCI center was 29 %. Median FMC-to-balloon time (CBT) was 135 min and door-to-balloon time (DBT) 70 min. With EP FMC DBT was 38 min with direct transfer to cath lab (n = 70), 69 min via ICU (n = 240), and 132 min via ER (n = 91, p < 0.01). Out of 826 pts, 143(17.3 %) presented in cardiogenic shock. In-hospital mortality was 8.8 % (n = 73), 35.7 % for shock pts versus 3.2 % for non-shock pts (p < 0.01). For pts receiving PPCI, in-hospital mortality was 6.2 %, for shock pts (n = 107) 28.0 %, and for non-shock pts (n = 573) 2.1 % (p < 0.01). CONCLUSION: Prehospital management, CBT and DBT compare favourably to data from studies and registries, but do not yet fulfill strict guideline requirements. Real world mortality in non-shock pts is very low. Direct transfer to cath lab reduces DBTs by 49 %. For this crucial improvement, transmission of a 12-lead ECG to the PPCI center is mandatory.
Authors: Peter H Nielsen; Christian J Terkelsen; Torsten T Nielsen; Leif Thuesen; Lars R Krusell; Per Thayssen; Henning Kelbaek; Ulrik Abildgaard; Anton B Villadsen; Henning R Andersen; Michael Maeng Journal: Am J Cardiol Date: 2011-07-15 Impact factor: 2.778
Authors: Ulrike M Müller; Ingo Eitel; Kristina Eckrich; Sandra Erbs; Axel Linke; Sven Möbius-Winkler; Meinhard Mende; Gerhard C Schuler; Holger Thiele Journal: Clin Res Cardiol Date: 2010-10-24 Impact factor: 5.460
Authors: Kim A Eagle; Brahmajee K Nallamothu; Rajendra H Mehta; Christopher B Granger; Philippe Gabriel Steg; Frans Van de Werf; Jose López-Sendón; Shaun G Goodman; Ann Quill; Keith A A Fox Journal: Eur Heart J Date: 2008-03 Impact factor: 29.983
Authors: Elizabeth H Bradley; Jeph Herrin; Yongfei Wang; Barbara A Barton; Tashonna R Webster; Jennifer A Mattera; Sarah A Roumanis; Jeptha P Curtis; Brahmajee K Nallamothu; David J Magid; Robert L McNamara; Janet Parkosewich; Jerod M Loeb; Harlan M Krumholz Journal: N Engl J Med Date: 2006-11-13 Impact factor: 91.245
Authors: R Zahn; A Vogt; U Zeymer; A K Gitt; K Seidl; M Gottwik; M A Weber; W Niederer; B Mödl; H-J Engel; U Tebbe; J Senges Journal: Heart Date: 2005-08 Impact factor: 5.994
Authors: Vincent G Haver; Minke H T Hartman; Irene Mateo Leach; Erik Lipsic; Chris P Lexis; Dirk J van Veldhuisen; Wiek H van Gilst; Iwan C van der Horst; Pim van der Harst Journal: Clin Res Cardiol Date: 2015-04-04 Impact factor: 5.460
Authors: Roman Pfister; Samuel Lee; Kathrin Kuhr; Frank Baer; Wolfgang Fehske; Hans-Wilhelm Hoepp; Stephan Baldus; Guido Michels Journal: PLoS One Date: 2016-06-03 Impact factor: 3.240