Abstract 213: Treatment Delays in Patients with ST-Elevation Myocardial Infarction Across All Hospitals Performing Primary Percutaneous Coronary Intervention in Quebec, Canada: Results of a Third Field Evaluation
Bibliographic record
Abstract
Background: Our government-funded independent cardiology evaluation unit conducted a third systematic province-wide field evaluation of ST-elevation myocardial infarction (STEMI) in collaboration with an interdisciplinary committee of clinical experts. Primary percutaneous coronary intervention (PPCI) is the predominant reperfusion treatment for STEMI in Quebec and in 2 previous evaluations (2006-7; 2008-9), there were wide variations in treatment delays across the 13 PPCI hospitals. Initiatives to improve delays have included individualized hospital report cards, presentations and discussions of inter-regional analyses with clinicians and decision-makers and the province-wide implantation of an ambulance (prehospital) ECG program. Our objective was to describe the differences in STEMI processes of care over time that these initiatives may have produced. Methods: Medical charts of all patients with a final diagnosis of acute myocardial infarction who presented with characteristic symptoms to an emergency department (ED) during a 6-month period in 2013-2014 were reviewed. Trained medical record librarians collected data on clinical characteristics and time points of care. An automated algorithm was used to identify STEMI. All patients with STEMI who presented directly to the ED of one of the 13 PPCI centers (by ambulance or other means) and were treated with PPCI were included in this preliminary analysis. ECGs were reviewed at our core laboratory. Results: During the 6-month study period, 735 patients with STEMI presented directly to the ED of a PPCI hospital (including ambulance bypass of local non-PPCI hospitals) and were treated with PPCI. Center patient volume varied from 29 to 117. Over 80% (596/735) of the patients arrived by ambulance (up from 71% in 2009-9) and of these, 93% (552/596) had a prehospital ECG compared with 20% in 2008-9. The median ED door-in-door-out delay was 26 min (10-90th percentile: 8-72) compared with 49 min (17-126) in 2008-9 (p=0.001). The median door-to-device delay was 59 min (30-125), compared with 77 min (38-163) during 2008-9 (p=0.017), and varied from a median of 38 to 87 min across the 13 PPCI hospitals. For patients arriving by ambulance with documented first medical contact time, 48% (260/541) had a first medical contact-to-device time ≤ 90 min compared with 35% in 2008-9 (p=0.06). Conclusions: This third province-wide evaluation shows important improvements in Quebec’s system of STEMI care. Since 2008-9, ED door-in-door-out delay improved by 47% and door-to-device delay for direct admission PPCI improved by 23%. These improvements have occurred after local, regional and provincial efforts to monitor and reduce treatment delays and the implantation of a province-wide prehospital ECG program. However, the wide variation in delays across PPCI centers underlines the need for continued evaluation and improvement initiatives.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.004 |
| Science and technology studies | 0.002 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".