Percutaneous coronary intervention (PCI) is the standard of care reperfusion therapy
in the management of STEMI. Timeliness is critical to the effectiveness of PCI and
shorter times to reperfusion are associated with decreased morbidity and mortality.
To expedite reperfusion, guidelines recommend STEMI patients should receive an ECG
within 10 minutes from initial presentation, represented as first medical contact
to electrocardiogram (FMC-to-ECG) time. Various factors have been suggested to impact
FMC-to-ECG time including triaged acuity, measured by the Canadian Triage and Acuity
Scale (CTAS). Designations of CTAS 1 and 2 indicate higher triage levels demanding
priority attention over CTAS 3, 4 or 5.
METHODS AND RESULTS
This is a retrospective observational study of three emergency departments (ED) within
a non-PCI capable health system. Walk-in patients with an ECG suggesting STEMI from
2017-2019 were identified (n=276). Charts were reviewed and only true walk-in patients
with a final diagnosis of STEMI and data necessary to calculate FMC-to-ECG times were
included (n=165). Furthermore, all patients with a chief complaint of chest pain presenting
to the three emergency departments during 2017-2019 were also identified to establish
a baseline CTAS triage rate. The primary objective of this study is to investigate
if ED triage acuity is associated with timely ECG in walk-in STEMI patients. 95% of
STEMI patients were triaged as CTAS 1 or 2 compared to 79.7% of all patients presenting
with a complaint of chest pain. 55% of STEMI patients with a CTAS 1 or 2 designation
received a timely ECG compared to 50% of STEMI patients with a CTAS 3, 4 or 5 designation.
Statistical analysis of proportions between groups was performed by using Chi squared
tests of independence or Fisher's exact test where appropriate.
Walk-in STEMI patients were significantly more likely to receive a higher priority
CTAS designation of 1 or 2 compared with any patient presenting with chest pain. Despite
the appropriate triage designation, only 55% of CTAS 1 or 2 patients received timely
ECGs and they were not more likely to receive a timely ECG over lower priority CTAS
designations. Taken together, these findings suggest the presence of a system-related
delay in FMC-to-ECG time. Interventions designed to improve the ability of patients
to receive ECGs and activate STEMI management pathways at the level of ED triage may
be helpful in identifying STEMI patients earlier, thereby expediting their reperfusion