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Pre- and early in-hospital procedures in patients with acute coronary syndromes: first results of the “German chest pain unit registry”

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Abstract

Background

In an attempt to improve the treatment of patients with acute coronary syndromes (ACS), a network of certified chest pain units (CPUs) has been recently established in Germany.

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.

Conclusion

The establishment of a nation-wide network of certified CPUs optimizes the medical treatment of patients with 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.

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Acknowledgments

This work was supported by the German Cardiac Society.

Author information

Authors and Affiliations

  1. 2nd Department of Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany

    Felix Post, Tommaso Gori & Thomas Münzel

  2. 3rd Department of Medicine, University Hospital Heidelberg, Heidelberg, Germany

    Evangelos Giannitsis & Hugo Katus

  3. Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany

    Thomas Riemer & Jochen Senges

  4. Department of Cardiology and Pneumology, Georg-August-University Göttingen, Göttingen, Germany

    Lars S. Maier

  5. Clinic for Cardiology and Angiology, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany

    Claus Schmitt

  6. 2nd Department of Medicine, Westpfalzklinikum Kaiserslautern, Kaiserslautern, Germany

    Burghard Schumacher

  7. Institute for Pathophysiology, School of Medicine Essen, Essen, Germany

    Gerd Heusch

  8. Department of Cardiology, Pneumology and Internal Intensive Care Medicine, Klinikum Neuperlach, Städtisches Klinikum München GmbH, Munich, Germany

    Harald Mudra

  9. Cardiovascular Center Bethanien, Frankfurt/Main, Germany

    Thomas Voigtländer

  10. Department of Cardiology, West-German Heart Centre University Essen, Essen, Germany

    Rainer Erbel

  11. Department of Cardiology, Angiology and Intensive Care Medicine, Vivantes Hospital Neukölln, Berlin, Germany

    Harald Darius

  12. Kerckhoff Klinik, Bad Nauheim, Germany

    Christian Hamm

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  1. Felix Post
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  2. Evangelos Giannitsis
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  3. Thomas Riemer
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  4. Lars S. Maier
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  9. Thomas Voigtländer
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  12. Hugo Katus
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  13. Christian Hamm
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  14. Jochen Senges
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Corresponding author

Correspondence to Tommaso Gori.

Additional information

J. Senges, T. Gori and T. Münzel contributed equally and should be considered as joint senior authors.

Appendix: Participants of the CPU registry

Appendix: Participants of the CPU registry

Institution

Town

Ostalb Klinikum Aalen

Aalen

St. Elisabeth Krankenhaus GmbH

Bad Kissingen

Kerckhoff-Klinik

Bad Nauheim

Herz- und Gefäßklinik GmbH

Bad Neustadt

Vivantes Klinikum Neukölln

Berlin

Charité Campus Virchow

Berlin

Charité Campus Mitte

Berlin

Vivantes Klinikum Am Urban

Berlin

Herzzentrum Brandenburg in Bernau

Bernau

Städtisches Klinikum Brandenburg GmbH

Brandenburg an der Havel

MVZ am Küchwald

Chemnitz

Klinikum Lippe- Detmold

Detmold

Universitätsklinikum Erlangen

Erlangen

Universitätsklinikum Essen

Essen

Philippusstift Essen

Essen

Elisabethkrankenhaus

Essen

Elisabethkrankenhaus

Essen

Klinikum Frankfurt-Höchst

Frankfurt am Main

Markus Krankenhaus

Frankfurt am Main

Bethanien Krankenhaus

Frankfurt am Main

Helios Kreiskrankenhaus Gotha GmbH

Gotha

Universitätsmedizin Göttingen

Göttingen

Krankenhaus Neu Bethlehem

Göttingen

Vinzenzkrankenhaus Hannover

Hannover

Ev. KH Hamm

Hamm

Universitätsklinikum Heidelberg

Heidelberg

Kliniken Heilbronn GmbH

Heilbronn

Westpfalz Klinikum

Kaiserslautern

St. Vincentius Krankenhaus

Karlsruhe

Städt. Klinikum

Karlsruhe

Asklepios Kliniken Langen-Seligenstadt

Langen

Klinikum Ludwigsburg

Ludwigsburg

Klinikum der Johannes Gutenberg Universität

Mainz

Kliniken Maria-Hilf

Mönchengladbach

Klinikum Neuperlach

Munich

Städt. Klinikum München Klinik Bogenhausen

Munich

Klinik Augustinum München

Munich

Lukaskrankenhaus

Neuss

Christliches KH

Quakenbrück

Klinikum Saarbrücken gGmbH

Saarbrücken

Herzklinik Ulm

Ulm

Katharinenhospital Unna

Unna

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Post, F., Giannitsis, E., Riemer, T. et al. Pre- and early in-hospital procedures in patients with acute coronary syndromes: first results of the “German chest pain unit registry”. Clin Res Cardiol 101, 983–991 (2012). https://doi.org/10.1007/s00392-012-0487-4

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