advanced life support paramedics. • Paramedics and computer software interpretation of the 3-lead and 12-lead PHECG of all STEMI subjects will be compared with a gold standard (defined as consensus between two investigators’ www.selleckchem.com/products/crenolanib-cp-868596.html independent interpretation blinded to paramedic or software interpretation)

Access to Interventions The rate of reperfusion strategy utilization across groups including fibrinolysis, Inhibitors,research,lifescience,medical percutaneous coronary angiography and intervention, coronary artery bypass surgery, bypass to PCI centre directly vs. transfer from a non PCI centre. Economic Outcomes • The direct costs of the 12 lead PHECG program will be estimated. • Impact on life expectancy gains through reductions in mortality based on the age and gender of subjects [33-35]; • Cost savings with survival benefits for the dominant Inhibitors,research,lifescience,medical treatment strategy or cost and outcome trade-offs if one treatment strategy demonstrates cost increasing with survival benefits • Incremental cost-effectiveness, as measured Inhibitors,research,lifescience,medical through additional cost per reduction in door-to-reperfusion time and additional cost per life year gained, will be calculated [36,37]. Patients

Enrolment A single trained data guardian/abstractor at each base hospital will screen all ambulance call reports and identify all eligible cases. Trained inhospital data abstractors will be notified to conduct a chart review at each receiving hospital. Data Management All prehospital and inhospital data will be abstracted by trained staff and entered on a web based interface employing a structured data set (Additional file 1 – Prehospital Data Variables and Additional Inhibitors,research,lifescience,medical file 2 – Inhospital Data Variables) that complies with institutional, privacy and ethical requirements. A manual of operations defines the data name, definition and abstraction instruction for each variable. Error and logic checks were built into the database to screen for abnormal values across forms and within forms at point of entry. Analysis Plan The primary outcome, and Inhibitors,research,lifescience,medical treatment time intervals,

will be analyzed with one-way ANOVA and subsequent pair-wise multiple comparison procedures across the four treatment strategies. Different covariates (Table ​(Table3)3) will be analyzed using multiple linear regressions and they will be introduced into the model and evaluated Montelukast Sodium as potential confounders. Variables will be retained if they have had an effect of 5% or greater on the coefficients for door-to-reperfusion time. Survival at 30 days and one year for STEMI patients will be analyzed as a binary outcome (Chi square) and as a survival analysis. Covariates that may affect survival will be analyzed with a Cox PH Regression Model. Adverse event rates will be analyzed with a Chi square analysis or a Fisher’s exact test.