Guideline-adherence regarding critical time intervals in the German Chest Pain Unit registry

GND
1032932163
Affiliation
Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Germany
Vafaie, Mehrshad;
GND
1128413051
Affiliation
Institute for Myocardial Infarction Research Foundation Ludwigshafen, Klinikum Ludwigshafen, Germany
Hochadel, Matthias;
GND
1171137788
Affiliation
Centre for Cardiology, Cardiology I, Johannes Gutenberg-University Mainz, Germany
Münzel, Thomas;
GND
122453301
Affiliation
Department of Cardiology, Catholic Clinics Essen-Northwest, Germany
Hailer, Birgit;
GND
1068294590
Affiliation
2nd Department of Medicine, Westpfalz-Klinikum, Kaiserslautern, Germany
Schumacher, Burghard;
GND
1065629672
ORCID
0000-0001-7078-4160
LSF
14631
Affiliation
Institute for Pathophysiology, West German Heart and Vascular Centre, University of Essen Medical School, Germany
Heusch, Gerd;
ORCID
0000-0002-6474-4469
Affiliation
CCB, Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany
Voigtländer, Thomas;
Affiliation
Department of Cardiology, Pneumology and Internal Intensive Care Medicine, Klinikum Neuperlach, Städtisches Klinikum München GmbH, Germany
Mudra, Harald;
GND
172490200
LSF
14508
Affiliation
Medical Clinic I, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Germany
Haude, Michael;
Affiliation
Department of Cardiology, Heart Centre Bad Neustadt, Bad Neustadt an der Saale, Germany
Barth, Sebastian;
GND
17236082X
Affiliation
Clinic for Cardiology and Angiology, Municipal Hospital Karlsruhe, Germany
Schmitt, Claus;
Affiliation
Department of Cardiology, Angiology and Intensive Care Medicine, Vivantes Klinikum Neukölln, Berlin, Germany
Darius, Harald;
GND
121480283
ORCID
0000-0001-9915-4429
Affiliation
Department of Internal Medicine II, University Hospital Regensburg, Germany
Maier, Lars S.;
GND
108916618
ORCID
0000-0002-2293-2314
Affiliation
Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Germany
Katus, Hugo A.;
GND
1027133479
Affiliation
Institute for Myocardial Infarction Research Foundation Ludwigshafen, Klinikum Ludwigshafen, Germany
Senges, Jochen;
GND
113336241
Affiliation
Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Germany
Giannitsis, Evangelos

Background: Since 2008, the German Cardiac Society certified 256 Chest Pain Units (CPUs). Little is known about adherence to recommended performance measures in patients with suspected acute coronary syndrome (ACS) presenting to CPUs. We investigated guideline-adherence regarding critical time intervals and selected performance measures in German Chest Pain Units.

Methods: From 2008 to 2014, 23,804 consecutive patients with suspected ACS were prospectively enrolled in the Chest Pain Unit registry of the German Cardiac Society.

Results: Median time from symptom onset to first medical contact was 2 h in patients with ST-elevation myocardial infarction (STEMI) and 4 h in patients with unstable angina and non-STEMI (NSTEMI). In patients with STEMI, median time from hospital admission to percutaneous coronary intervention (PCI) was 40 min and median time from first medical contact to PCI was 1 h 35 min. Primary PCI was performed in 94.7% of patients with STEMI, 70.0% of patients with NSTEMI and 37.4% of patients with unstable angina. PCI was performed during the first 24 h in 79.5% of patients with NSTEMI and the first 72 h in 89.0% of patients with unstable angina. Electrocardiograms were performed in 99.5% after a median of 6 min after admission and obtained within 10 min in 71%. Interestingly, 56.1% of patients were found to have non-ACS diagnoses, underlining the importance of access to additional diagnostic modalities including echocardiography, stress testing or computed tomography.

Conclusions: Guideline-adherence regarding critical time intervals and primary PCI rates is good in German Chest Pain Units. More than half of patients admitted with suspected ACS had non-ACS diagnoses. Improvements in pre-hospital time delays through public awareness programmes are warranted.

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© The European Society of Cardiology 2018

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