STEMI patients may have faster reperfusion times and lower mortality rates if emergency medical service (EMS) teams notify cardiac catheterization (cath) labs before the patient arrives at the hospital, according to a study published Sept. 17 in JACC: Cardiovascular Interventions.

Using data from ACC's Chest Pain – MI Registry, Jay S. Shavadia, MD, et al., evaluated the association between cath lab pre-activation and reperfusion timing and in-hospital mortality for 27,840 STEMI patients who were transported by EMS to 744 hospitals from January 2015 to March 2017.

Results showed that cath labs were pre-activated more than 10 minutes before arrival for 41 percent of patients (11,379), while pre-activation occurred in 10 minutes or less for 33.5 percent of patients (9,326). The cath lab was activated at hospital arrival or after for the remaining 25.6 percent of patients (7,135). The authors found that every 10-minute delay in cath lab activation was associated with increased reperfusion time.

Overall, cath lab pre-activation was associated with a 12-minute decrease in door-to-balloon time and a higher proportion of patients achieving first medical contact-to-device times of 90 minutes or less. The decrease in door-to-balloon times occurred for patients who presented during both work hours and off hours. In addition, the in-hospital mortality rate was 2.8 percent among patients who were transferred to a cath lab that had been pre-activated, compared with 3.4 percent among patients who were transferred to a lab that had not been pre-activated.

According to the authors, there is a need for a better understanding of when cath lab activation occurs in the time before a patient arrives at the hospital. They conclude that their results "highlight opportunities to optimize the implementation" of cath lab pre-activation.

Keywords: Hospital Mortality, Emergency Medical Services, Registries, Chest Pain, Cardiac Catheterization, National Cardiovascular Data Registries, Chest Pain MI Registry

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