Document Detail


Pre-hospital triage for primary angioplasty: direct referral to the intervention center versus interhospital transport.
MedLine Citation:
PMID:  20650431     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We sought to study the impact of direct referral to an intervention center after pre-hospital diagnosis of ST-segment elevation myocardial infarction (STEMI) on treatment intervals and outcome.
BACKGROUND: Primary angioplasty has become the preferred reperfusion strategy in STEMI. Ambulance diagnosis and direct referral to an intervention center is an attractive treatment option that has not been studied extensively.
METHODS: Consecutive pre-hospital patients with STEMI, who were referred to our intervention center for primary angioplasty between 2005 and 2007, were studied. After pre-hospital diagnosis, patients were either directly transported to our center or referred through a nonintervention center. The catheterization laboratory was activated before transport to the intervention center.
RESULTS: Of the 581 patients referred, 454 (78%) came with direct transport and 127 (22%) through a nonintervention center. Direct transport was associated with a higher proportion of patients treated within the 90-min time window of the STEMI guidelines: 82% versus 23% (p < 0.01). Patients directly transported had a significantly shorter median symptom-to-balloon time of 149 min (Interquartile range: 118 to 197 min) versus 219 min (interquartile range: 178 to 315 min), p < 0.01, a higher post-procedural Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 rate (92% vs. 84%; p = 0.03), and a lower 1-year mortality rate (7% vs. 13%; p = 0.03). Direct transport to the intervention center was independently associated with the symptom-to-balloon time, which in turn was an independent predictor of post-procedural TIMI flow grade 3, a strong prognosticator of outcome.
CONCLUSIONS: After ambulance-based diagnosis of STEMI, direct transport to an intervention center with pre-hospital notification of the catheterization laboratory more than triples the proportion of patients treated within the time window of the guidelines. Time to balloon was an independent predictor of post-procedural TIMI flow grade 3, which underscores the need to reduce treatment delays.
Authors:
Hendrik-Jan Dieker; Stephan S B Liem; Hamza El Aidi; Pierre van Grunsven; Wim R M Aengevaeren; Marc A Brouwer; Freek W A Verheugt
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  JACC. Cardiovascular interventions     Volume:  3     ISSN:  1876-7605     ISO Abbreviation:  JACC Cardiovasc Interv     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-23     Completed Date:  2010-11-08     Revised Date:  2012-08-29    
Medline Journal Info:
Nlm Unique ID:  101467004     Medline TA:  JACC Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  705-11     Citation Subset:  IM    
Copyright Information:
Copyright 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Cardiology, Heart Lung Center, Radboud University Medical Center, Nijmegen, the Netherlands. h.dieker@cardio.umcn.nl
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MeSH Terms
Descriptor/Qualifier:
Aged
Ambulances*
Angioplasty, Balloon, Coronary* / adverse effects,  mortality
Chi-Square Distribution
Emergency Medical Services*
Female
Guideline Adherence
Health Services Accessibility*
Humans
Kaplan-Meier Estimate
Logistic Models
Male
Middle Aged
Myocardial Infarction / diagnosis,  mortality,  therapy*
Netherlands
Patient Care Team
Patient Transfer*
Practice Guidelines as Topic
Proportional Hazards Models
Prospective Studies
Referral and Consultation*
Residence Characteristics
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Triage*
Comments/Corrections
Comment In:
JACC Cardiovasc Interv. 2010 Oct;3(10):1093-4; author reply 1094-5   [PMID:  20965473 ]
JACC Cardiovasc Interv. 2010 Oct;3(10):1093; author reply 1094-5   [PMID:  20965472 ]
JACC Cardiovasc Interv. 2010 Jul;3(7):712-4   [PMID:  20650432 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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