SAEM Western Regional 2012 - Walk In STEMI
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Transcript of SAEM Western Regional 2012 - Walk In STEMI
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SAEM Western Regional Meeting, March 17, 2012
Garren M.I. Low, MS
LAC+USC Medical Center
Los Angeles, CA
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Ethnic Disparities in the Utilization of EMS Resources and the Impact on Door-To-PCI Times in STEMI PatientsNick Testa, M.D.; Garren Low, MS;
David Shavelle, M.D.; Stephanie Hall, M.D.;
Kim Newton, M.D.; Linda Chan, Ph.D.
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Background
LAC+USC is a STEMI Receiving Center (since January 2008)
National standard for Door-to-PCI time is ≤90 minutes
Previous research from LAC+USC showed Hispanics have disproportionately long Door-to-PCI time
Hispanic-Americans STEMI patients have been shown to have poorer times and outcomes in the literature
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Methods
All patients treated for STEMI at LAC+USC January 2009 – June 2011
Data prospectively collected by cross trained-CCU nurses: “STEMI Nurses” Data cleaned by Project Coordinator &
Biostatistics staff
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Results
494 patients over this time period 276 (56%) Hispanic 95 (19%) African American 64 (13%) Asian 59 (12%) Caucasian
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Results: % of cases with Door-To-PCI time ≤90 Minutes
EMS Walk-In Subtotal
Hispanics 55/60 (92%) 48/77 (62%) 103/137 (75%)
African Americans 20/21(95%) 1/4 (25%) 21/25 (84%)
Subtotal 75/81 (92%) 49/81 (60%) 124/162 (77%)
Crude Odds Ratio (Hispanic vs. AA) 0.58 (95%CI: 0.16, 1.95; p=0.48)
Adjusted Odds Ratio (Hispanic vs. AA) 1.54 (95%CI: 0.33, 6.63; p=0.80)
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Results: EMS Utilization
African American STEMI Patients utilized EMS 70% of the time
Hispanic STEMI Patients utilized EMS 40% of the time
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Discussion
The reverse relationship between the Crude Odds Ratio and Adjusted Odds ratio Suggests that there is an interaction between
Entry Mode (EMS Utilization) and the Door-to-PCI time, as viewed by ethnicity
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Conclusion
Significant difference between EMS and Walk-In STEMI patients’ Door-to-PCI times
No significant difference between African American and Hispanic STEMI patients after adjusting for EMS utilization.
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Limitations
Data is from one medical center Population is multicultural, urban
Small sample size Paper will look at a longer time period
No adjustment for patient co-morbidities
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No Conflicts of Interest
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Questions?