Abstract
BackgroundFor each hour of delay from fist medical contact until reperfusion in ST-elevation myocardial infarction (STEMI) there is a 10% increase in risk of death and heart failure. The aim of this review is to describe the impact of the direct admission of patients with STEMI to a Catheterisation laboratory (cath lab) as compared with transport to the emergency department (ED) with regard to delays and outcome.MethodsDatabases were searched for from April-June 2012 and updated January 2014: 1) Pubmed; 2) Embase; 3) Cochrane Library; 4) ProQuest Nursing and 5) Allied Health Sources. The search was restricted to studies in English, Swedish, Danish and Norwegian languages.The intervention was a protocol-based clinical pre-hospital pathway and main outcome measurements were the delay to balloon inflation and hospital mortality.ResultsMedian delay from door to balloon was significantly shorter in the intervention group in all 5 studies reported. Difference in median delay varied between 16 minutes and 47 minutes.In all 7 included studies the time from symptom onset or first medical contact to balloon time was significantly shorter in the intervention group. The difference in median delay varied between 15 minutes and 1 hour and 35 minutes. Only two studies described hospital mortality. When combined the risk of death was reduced by 37%.ConclusionAn overview of available studies of the impact of a protocol-based pre-hospital clinical pathway with direct admission to a cath lab as compared with the standard transport to the ED in ST-elevation AMI suggests the following. The delay to the start of revascularisation will be reduced. The clinical benefit is not clearly evidence based. However, the documented association between system delay and outcome defends the use of the pathway.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-014-0067-x) contains supplementary material, which is available to authorized users.
Highlights
During the last few decades, the treatment of patients with a presumed acute coronary syndrome (ACS) has focused on the concept of “time is muscle”
The median delay was significantly shorter in the intervention group in all five studies
Onset of symptoms or first medical contact to balloon time In all seven included studies [21,22,23,25,26,27,28], the time from symptom onset or first medical contact to balloon time was significantly shorter in the intervention group
Summary
During the last few decades, the treatment of patients with a presumed acute coronary syndrome (ACS) has focused on the concept of “time is muscle” This concept has become relevant with regard to patients with ST-segment-elevation myocardial infarction (STEMI) and reperfusion therapy [1,2]. Since the start of these individual experiences, a number of observational studies have attempted to explore the effect, on patients with STEMI, of direct admission to a catheterisation laboratory (cath lab) or CCU as compared with the traditional transport to the emergency department (ED) In these studies, the aim has been to address the effect on delay and possible effects on patient outcome.
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