Abstract
BackgroundFirst medical contact (FMC)-to-balloon time is associated with outcome of ST-elevation myocardial infarction (STEMI). We assessed the impact on mortality and the determinants of indirect vs. direct transfer to the cardiac catheterization laboratory (CCL).MethodsWe analyzed data from 2,206 STEMI patients consecutively included in a prospective multiregional percutaneous coronary intervention (PCI) registry. The primary endpoint was 1-year mortality. The impact of indirect admission to CCL on mortality was assessed using Cox models adjusted on FMC-to-balloon time and covariables unequally distributed between groups. A multivariable logistic regression model assessed determinants of indirect transfer.ResultsA total of 359 (16.3%) and 1847 (83.7%) were indirectly and directly admitted for PCI. Indirect admission was associated with higher risk features, different FMCs and suboptimal pre-PCI antithrombotic therapy.At 1-year follow-up, 51 (14.6%) and 137 (7.7%) were dead in the indirect and direct admission groups, respectively (adjusted-HR 1.73; 95% CI 1.22–2.45). The association of indirect admission with mortality was independent of pre-FMC and FMC characteristics. Older age, paramedics- and private physician-FMCs were independent determinants of indirect admission (adjusted-HRs 1.02 per year, 95% CI 1.003–1.03; 5.94, 95% CI 5.94 3.89–9.01; 3.41; 95% CI 1.86–6.2, respectively).ConclusionsOur study showed that, indirect admission to PCI for STEMI is associated with 1-year mortality independent of FMC to balloon time and should be considered as an indicator of quality of care. Indirect admission is associated with higher-risk features and suboptimal antithrombotic therapy. Older age, paramedics-FMC and self-presentation to a private physician were independently associated with indirect admission. Our study, supports population education especially targeting elderly, more adequately dispatched FMC and improved pre-CCL management.
Highlights
Primary percutaneous coronary intervention (PCI) is the firstline treatment for ST-elevation myocardial infarction (STEMI) (1)
The national emergency medical services (EMS) number was called directly by 1,245 (56%) patients for whom medical doctor (MD)- or paramedics-EMS team were sent on scene in 1,090 (88%) and 110 (9%), respectively while others were directed to their MD (0.5%) or an emergency department (ED) (2.5%)
Our analysis showed that age, paramedics-EMS and privateMD first medical contact (FMC) were associated with indirect admission independent of FMC to balloon time and other pre-FMC variables
Summary
Primary percutaneous coronary intervention (PCI) is the firstline treatment for ST-elevation myocardial infarction (STEMI) (1). System delays from the first medical contact (FMC) to cardiac catheterization laboratory (CCL) are associated with poor outcome (2–4) and should be reduced to the minimum (1). Indirect admission to the CCL and the number of contacts, after the FMC, are associated with longer system delays and total ischemic time but their impact on mortality, independent of system delays remains controversial (7, 8). The objective of our study was to investigate whether indirect admission to CCL impacted mortality independent of FMC to balloon time and other identified co-variables in patients enrolled in a STEMI networks within 24 h following symptom onset and admitted to CCL for primary PCI. First medical contact (FMC)-to-balloon time is associated with outcome of ST-elevation myocardial infarction (STEMI). We assessed the impact on mortality and the determinants of indirect vs direct transfer to the cardiac catheterization laboratory (CCL)
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