Pre- and early in-hospital procedures in patients with acute coronary syndromes: first results of the German chest pain unit registry
Clinical Research in Cardiology,

Post F et al. – The establishment of a nation–wide network of certified chest pain units (CPUs) optimizes the medical treatment of patients with acute coronary syndromes (ACS) while providing an ideal infrastructure to evaluate and improve, both on a nation–wide and a single center scale, the adherence to guidelines. The median delay between symptom onset and first medical contact remains high. Although performed relatively rarely, a pre–hospital ECG facilitates earlier diagnosis of a STEMI in a large majority of patients. The introduction of CPUs minimizes in–hospital delays and exploits the benefit of invasive diagnostics and treatment.

Methods
  • Data from patients admitted between December 2008 and September 2011 for ACS in 40 certified CPUs participating in the registry were prospectively collected.

Results
  • A total of 5,457 patients was admitted for ACS; 798 patients (14.6 %) were diagnosed with an ST–elevation myocardial infarction (STEMI), 2,244 (41.1 %) with a non–ST–elevation myocardial infarction (NSTEMI), and 2,415 (44.3 %) with unstable angina. The mean time to first medical contact was 2:08 h for STEMI patients.
  • A pre–hospital ECG was available in 23.8 % of all ACS patients.
  • Importantly, evidence of ST–segment elevation was present in 79.7 % of the STEMI patients already in this pre–hospital ECG.
  • As many as 76.6 % of the patients, independently of their symptoms and final diagnosis, received an ECG within 10 min of reaching the CPU. 98.2 % of STEMI patients underwent invasive diagnostics, with an in–hospital delay as little as 31 (11–75) min.

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