ABSTRACTS
Survivorship with Incrementally Faster Times to Primary Percutaneous Coronary Intervention (SWIFT-PCI): Development of a Time:Survival Calculation to Inform Transport Decision-making in ST-Elevation Myocardial InfarctionAuthor: Jordan Rudman, MD | | Associate Authors: David Schoenfeld, MD MPH, Jonathan Shecter, DO, James Price, MB ChB, Michael McCartin, MD, Paul Rees, MBBS, Ira Blumen, MD, Stephen H. Thomas, MD, MPH
Introduction Despite frequent recommendations to consider time savings in transport mode decision-making for ST-elevation myocardial infarction (STEMI), few data explicitly tie incremental minutes’ savings to a specific number of lives gained. This study, Survivorship With Incrementally Faster Times to Percutaneous Coronary Intervention (SWIFT-PCI), was executed to derive an estimate of lives saved per incremental pre-PCI time savings. Methods A systematic review (search terms “time,” “PCI,” “survival OR mortality”) was conducted to identify evidence defining incremental pre-PCI time savings’ absolute number of lives saved. Included studies were those that provided a specific absolute risk reduction (ARR) for a specific reduction in pre-PCI time. Eligible studies evaluated survival benefit from pre-PCI time savings measured in any interval ending with PCI (“balloon” time), with objectively recorded timing commencement such as initial emergency call, first medical contact (FMC), or hospital arrival (“door” time). Results Of 1,088 publications, 52 were reviewed in full-text with N = 4 studies (total patient n = 235,814, with overall mortality 4.7–7.8%) used as basis for calculations. All four studies reported significant incremental time-savings survival benefit. The number of lives saved per 100 cases for each 30-minute pre-PCI time savings (over this analysis’s focus of 1–3 hours pre-PCI) ranged from 0.8 to 1.9. Two of four studies found a constant ARR over the time frame of 1–3 hours, whereas the other two found that the ARR varied depending on the time of PCI. Conclusions Based solely on benefit from time savings, the general population of STEMI cases undergoing PCI within 1–3 hours of presentation is estimated to benefit from each 30 minutes’ pre-PCI time savings by a factor of 0.8–1.9 lives saved for each 100 cases. Savings of each 30 minutes is associated with one additional survival for each 50–100 cases. The data suggests a greater benefit to time savings in more critical cases, but there are insufficient data to calculate precise time savings’ benefit for special populations such as OHCA and cardiogenic shock. These calculations can inform STEMI systems’ planning for transport-mode triage.
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