Implementation of a pre-hospital network favoring primary angioplasty in STEMI to reduce mortality: The Algarve Project

Abstract

ObjectiveTo analyze the impact of reperfusion by either primary percutaneous coronary inter-vention (PPCI) or fibrinolysis, and mortality rates of a pre-hospital fast-track network for treating patients with ST-elevation myocardial infarction (STEMI). Methods and ResultsA pre-hospital network for STEMI patients, designated the Green Lane for Acute Myocardial Infarction (GL-AMI), has been implemented in the southern region of Portugal - the Algarve Project. We performed an observational study based on a prospective registry of 1338 patients admitted to Faro Hospital between 2004 and 2009, classified in two groups according to the method of admission: emergency department group (EDG) and GL-AMI group (GLG). More patients from GLG were reperfused (p<0.0001). PPCI was the preferred method of reperfusion, 73.1% in GLG and 45.3% in EDG. Time delays were significantly shorter in GLG, except for pre-hospital delay: pre-hospital delay (p=0.11); door-to-needle (p<0.0001); door-to-balloon (p<0.0001); and delay between symptoms and reperfusion (p<0.0001). In-hospital mortality (4.3% vs 9.2%, p=0.0007) and 6-month mortality (6.3% vs 13.8%, p<0.0001) were significantly lower in GLG. ConclusionsThe Algarve Project significantly reduced the time delay between onset of symp-toms and reperfusion, significantly increased the rate of reperfusion, and significantly reduced in-hospital and six-month mortality.