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Prehospital STEMI Activation of the Cath Lab

Question Type:
Intervention
Full Question:
Among adult patients with suspected STEMI outside of a hospital

 (P), does does prehospital activation of catheterization laboratory

 (I), compared with compared with no prehospital activation of the catheterization laboratory
 (C), change short term mortality, major bleeding, non-fatal stroke, non-fatal re-infarction (O)?
Consensus on Science:
For the critical outcome of 30-day mortality, we have identified moderate-quality evidence (upgraded for large effect size) from 6 observational studies(Le May 2006, 1329-1333; Carstensen 2007, 2313-2319; Brown 2008, 158-161; Qiu 2011, 805-810; Sorensen 2011, 430-436; Horvath 2012, 186-192) enrolling 1805 patients in favor of prehospital activation of the catheterization laboratory over no activation of catheterization laboratory (odds ratio [OR], 0.41; 95% CI, 0.30–0.56) (Figure 3).For the important outcome of major bleeding, we have identified very-low-quality evidence (downgraded for imprecision) from 1 observational study(Horvath 2012, 186-192) enrolling 188 patients showing no benefit of prehospital activation of catheterization laboratory over no activation of catheterization laboratory (OR, 0.68; 95% CI, 0.04–10.68).For the important outcome of nonfatal stroke, we have identified very-low-quality evidence (downgraded for imprecision) from 1 observational study(Carstensen 2007, 2313-2319) enrolling 301 patients showing no benefit of prehospital activation of catheterization laboratory over no activation of catheterization laboratory (OR, 0.06; 95% CI, 0.00–1.13).For the important outcome of nonfatal reinfarction, we have identified very-low-quality evidence (downgraded for imprecision) from 3 observational studies(Carstensen 2007, 2313-2319; Qiu 2011, 805-810; Horvath 2012, 186-192) enrolling 748 patients showing no benefit of prehospital activation of catheterization laboratory over no activation of catheterization laboratory (OR, 0.48; 95% CI, 0.22–1.03).
Treatment Recommendation:
We recommend that when primary PCI is the planned strategy, that prehospital activation of catheterization laboratory for PPCI is preferred (strong recommendation, very-low-quality evidence) over no prehospital activation.Values, Preferences, and Task Force Insights In making this recommendation, we place higher value of benefit to patient outcomes over the potential increased resource utilization.
CoSTR Attachments:
ACS_873 Evidence Profile data_V2_n.docx    
AMSTAR_ACS 873.pdf    

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