Abstract
AimsTo evaluate the relation between residential distance and total ischaemic time in patients with acute ST-elevation myocardial infarction (STEMI).MethodsSTEMI patients were transported to the Isala Hospital Zwolle with the intention to perform primary percutaneous coronary intervention PCI (pPCI) from 2004 until 2010 (n = 4149). Of these, 1424 patients (34 %) were referred via a non-PCI ‘spoke' centre (‘spoke’ patients) and 2725 patients (66 %) were referred via field triage in the ambulance (ambulance patients).ResultsA longer residential distance increased median total ischaemic time in ‘spoke’ patients (0–30 km: 228 min, >30-60 km: 235 min, >60-90 km: 264 min, p < 0.001), however not in ambulance patients (0–30 km: 179 min, >30-60 km: 175 min, >60-90 km: 186 min, p = 0.225). After multivariable linear regression analysis, in ‘spoke’ patients residential distance of >30-60 km compared with 0–30 km was not independently associated with ischaemic time; however, a residential distance of >60-90 km (exp (B) = 1.11, 95 % CI 1.01-1.12) compared with 0–30 km was independently related with ischaemic time. In ambulance patients, residential distance of >30-60 and >60-90 km compared with 0–30 km was not independently associated with ischaemic time.ConclusionA longer distance from the patient’s residence to a PCI centre was associated with a small but significant increase in time to treatment in ‘spoke’ patients, however not in ambulance patients. Therefore, referral via field triage in the ambulance did not lead to a significant increase in time to treatment, especially at long distances (up to 90 km).
Highlights
Strategies to reduce time delays in ST-segment elevated myocardial infarction (STEMI) patients are currently of great interest, since shorter time delays improve outcome [1,2,3,4,5]
Referral via field triage in the ambulance did not lead to a significant increase in time to treatment, especially at long distances
The total ischaemic time is shown for the spoke group (a) and the ambulance group (b) for patients living 0–30 km, >30-60 km and >60-90 km from a percutaneous coronary intervention (PCI) centre
Summary
Strategies to reduce time delays in ST-segment elevated myocardial infarction (STEMI) patients are currently of great interest, since shorter time delays improve outcome [1,2,3,4,5]. Transportation delay is a time delay which is mainly dependent on the type of transport, mode of referral, geographical area, weather conditions, traffic and distance. Previous studies have shown that optimising logistics by field triage in the ambulance can help to reduce time to treatment and improve outcomes compared to referral via a non-percutaneous coronary intervention (PCI) spoke centre (peripheral centre) [5,6,7,8,9,10,11,12]. A few published data exist on the effect of geographical area [8, 13,14,15,16], weather conditions [16], traffic [16] and distance [5, 16,17,18,19] on time to treatment.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
