Prehospital Evaluation and Economic Analysis of Different Coronary Syndrome Treatment Strategies - PREDICT
This trial is active, not recruiting.
|Conditions||myocardial ischemia, myocardial infarction|
|Sponsor||St. Joseph's Healthcare Hamilton|
|Start date||February 2009|
|End date||March 2013|
|Trial size||400 participants|
|Trial identifier||NCT00747656, HTA006-0708-01|
Despite remarkable gains in treatment over the last decade short-term mortality for those who survive to hospital with AT-elevation acute myocardial infarction (STEMI) remains high (5%-10%). Different studies have pointed out that reperfusion (intravenous fibrinolysis or percutaneous coronary interventions (PCI) and its timing are critical in decreasing STEMI patients' mortality. Studies of prehospital 12 lead electrocardiograms (12 lead PHECG) with advance emergency department (ED) notification suggest that there is a time to treatment advantage with this intervention. The use of 12 lead PHECG is not currently universal and part of standard treatment throughout the province. The purpose of the study is to follow STEMI study subjects during standard treatments and to compare the outcomes of subjects that received 12 lead PHECG with advanced ED notification in mixed rural/urban areas with outcomes of subjects treated in areas with only 3 lead PHECG monitoring and indirect ED notification. The investigators hypothesize that there will be a survival benefit for study subjects with 12 lead PHECG and advance ED notification in rural and urban environments through a reduction in door-to-reperfusion time and that 12 lead PHECG will be a cost-saving technology for the province of Ontario.
|United States||No locations recruiting|
|Other Countries||No locations recruiting|
|Alliston, Canada||Stevenson Memorial Hospital||no longer recruiting|
|Newmarket, Canada||Southlake Regional Health Centre||no longer recruiting|
|Sudbury, Canada||Sudbury Regional Hospital||no longer recruiting|
|Toronto, Canada||Sunnybrook Health Scineces Centre||no longer recruiting|
|Toronto, Canada||Rouge Valley||no longer recruiting|
Comparison of the time from arrival to the ED to initiation of the reperfusion therapy between those receiving 12 lead PHECG and those receiving 3 lead PHECG monitoring prior to hospital arrival.
time frame: 24 hours
Survival at 30 days
time frame: 30 days
time frame: 1 year
Male or female participants at least 18 years old.
Inclusion Criteria: - Call 911 for assistance - Are suspected by the paramedics of having ischemic chest pain for greater than 30 minutes but less than 6 hours - Be greater than or equal to 18 years of age - Experience chest pain that fails to completely respond to nitrates as per standard provincial chest pain protocol. Exclusion Criteria: - Subjects less than 18 years of age
|Official title||The Impact of Prehospital 12 Lead ECG With Advanced Emergency Department Notification on Time to In-hospital Reperfusion Strategy in Patients With Acute ST Segment Elevation Myocardial Infarction - A Prospective Study|
|Principal investigator||Laurie Morrison, MD, MSc|
|Description||Many studies have established that reperfusion reduces mortality in ST-elevation acute myocardial infarction (STEMI) patients; the earlier reperfusion therapy is delivered, the greater the mortality reduction. Most STEMI patient in Ontario still do not receive reperfusion therapy within established target times of <30 minutes for fibrinolysis or <90 minutes for PCI. 12 lead PHECG with advance ED notification may have a time to treatment impact in STEMI patients. However studies, investigating this intervention were all small, largely urban trials, and were carried out with advanced care paramedics. In Ontario, many emergency medical services (EMS) systems cover large rural regions, and are frequently staffed by primary care paramedics with only basic life support training. Thus, the benefit of 12 lead PHECG in these settings is unclear. In addition, no study has assessed the cost-effectiveness of 12 lead PHECG compared to 3 lead PHECG.|
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