ArticleAcademic emergency medicine : official journal of the Society for Academic Emergency Medicine2023
Delayed first medical contact to reperfusion time increases mortality in rural emergency medical services patients with ST-elevation myocardial infarction.
Article in Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Sex differences in rural prehospital ST-segment elevation myocardial infarction care.Emergency medicine journal : EMJ · 2026Article
- Behavioral Determinants Potentially Relevant to First-Witness Responses in Prehospital Stroke Care: A COM-B-Based Scoping Review.Healthcare (Basel, Switzerland) · 2026Review
- Pre-Hospital Delay in STEMI: A Narrative Review of Symptom Onset-to-First Medical Contact Across High-Income and Low- and Middle-Income Countries.Clinical cardiology · 2026Review
- Door-to-Balloon Time in Patients with ST-Segment Elevation Myocardial Infarction (STEMI) in Iran: A Systematic Review and Meta-Analysis.Research in heart yield and translational medicine · 2026Review
- Association between door-to-wire time and 30-day mortality after PCI in patients with acute myocardial infarction: evidence from a single-center study in the China chest pain center registry.Frontiers in cardiovascular medicine · 2026Article
- Mixed-Methods Investigation of Rural Emergency Medical Services ST-Elevation Myocardial Infarction Time to Percutaneous Coronary Intervention: High- vs Low-Performing Agencies.The western journal of emergency medicine · 2025Article
- Article
- Treatment and Care of Patients with ST-Segment Elevation Myocardial Infarction-What Challenges Remain after Three Decades of Primary Percutaneous Coronary Intervention?Journal of clinical medicine · 2024Review
- Rural EMS STEMI Patients - Why the Delay to PCI?Prehospital emergency care · 2024Article
- Feasibility of implementing reperfusion strategies in STEMI codes in a mountainous population remote from a PCI-capable center.REC, interventional cardiologyArticle
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Authors and funding
6 authors.
Funding
Abstract
backgroundST-elevation myocardial infarction (STEMI) guidelines recommend an emergency medical services (EMS) first medical contact (FMC) to percutaneous coronary intervention (PCI) time of ≤90 min. The primary objective of this study was to evaluate the association between FMC to PCI time and mortality in rural STEMI patients.
methodsWe conducted a cohort study of patients ≥18 years old with STEMI activations from January 2016 to March 2020. Data were obtained from a rural North Carolina Regional STEMI Data Registry, which included eight rural EMS agencies and three PCI centers, the National Cardiovascular Data Registry, and the EMS electronic health record. Prehospital and in-hospital time intervals were digitally abstracted. The outcome of index hospitalization mortality was compared between patients who did and did not meet FMC to PCI time goal using Fisher's exact tests. Negative predictive value (NPV) for index hospitalization death was calculated with 95% confidence intervals (CIs). A receiver operating characteristic curve was constructed and an optimal FMC to PCI time goal was identified by maximizing NPV to prevent index hospitalization death.
resultsAmong 365 rural EMS STEMI patients, 30.1% (110/365) were female with a mean ± SD age of 62.5 ± 12.7 years. PCI was performed within the 90-min time goal in 60.5% (221/365) of patients. Among these patients, 3% (11/365) died during initial STEMI hospitalization, with 1.4% (3/221) mortality in the group that met the 90-minute time goal compared to 5.6% (8/144) in patients exceeding the time goal (p = 0.03). Meeting the 90-min time goal yielded a 98.6% (95% CI 96.1%-99.7%) NPV for index death. A 78-min FMC to PCI time was the optimal cut point, yielding a NPV for index mortality of 99.3% (95% CI 96.1%-100%).
conclusionsDeath among rural patients with STEMI was four times more likely when they did not receive PCI within 90 min.
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