Abstract
In ST-elevation myocardial infarction (STEMI), the pre-hospital phase is the most critical and appropriate treatment in a timely manner which is instrumental for mortality reduction. STEMI systems of care based on networks of medical institutions connected by an efficient emergency medical service (EMS) are pivotal. The first steps are devoted to minimizing patient’s delay in seeking care, quickly dispatching emergency personnel with equipped ambulance to be able to make the diagnosis on scene, deliver initial drug and therapy and also transport the patient to the most appropriate (not necessarily the closest) cardiac facility or hospital. Primary percutaneous coronary intervention (PCI) is a treatment of choice, but thrombolysis followed by coronary angiography and possibly PCI are valid alternatives. Strong cooperations between cardiologists and emergency medicine doctors are mandatory for optimal pre-hospital STEMI care. In this study, we prospectively recorded door to balloon time (DBT) for consecutive patients with STEMI, treated by PCI. For six hundred and seventy seven patients with mean 64 ± 16 years, 475 (70%) males and 202 (30%) females were enrolled for the final analysis. From this number, 354 (52.3%) patients had primary transport by emergency services (PT) and 323 (47.7%) secondary transport (ST). Median of DBT was 34 ±15.9 mins for PT patients (n=354) and 100 ±28.8 mins for patients with ST (n=323) (p<0.00005). One month mortality rate was 4% vs 9.5% (p=0.002) in the PT vs ST group, respectively. One-year mortality rate in the PT and ST groups were 7.3% vs 20.5% (p<0.005), respectively. We found out that patients who were sent directly to a PCI center had significantly shorter time for reperfusion and lower mortality.
Highlights
The importance of time aspects in the treatment of patients with secondary transport (ST) segment elevation myocardial infarction (STEMI) is stressed both in the American College of Cardiology and the European Society of Cardiology guidelines [1, 2]
Basic clinical data of patients in the study as shown in table (1) and localization of the STEMI in the original group of 869 patients referred to the tertiary center shown in table (2)
From this basic cohort a total of 192 patients were not enrolled for the final analysis, the reasons were shown in Table (3). 677 patients, age 37-96 years, mean 64 ± 16 years, 475 (70%) of them males and 202 (30%) females, were enrolled for the final analysis
Summary
The importance of time aspects in the treatment of patients with ST segment elevation myocardial infarction (STEMI) is stressed both in the American College of Cardiology and the European Society of Cardiology guidelines [1, 2]. A primary transport (PT) of a patient with STEMI directly into the Cardiac Centers with feasibility of an immediate primary percutaneous coronary intervention (PCI) and not to the nearest hospital is recommended [1, 2]. Organization of care for patients with STEMI, especially with compression times since the onset of symptoms to perform d-PCI is unthinkable without closed cooperation between Cardiac Center and the medical emergency services. The diagnostics as well as determining direction of the initial treatment are handled . Direction and determining treatment on the site of the event in case of medical crew pharmacists
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