European Heart Journal Advance Access originally published online on January 31, 2005
European Heart Journal 2005 26(8):770-777; doi:10.1093/eurheartj/ehi100
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Reduction of treatment delay in patients with ST-elevation myocardial infarction: impact of pre-hospital diagnosis and direct referral to primary percutanous coronary intervention
1Department of Cardiology, Skejby University Hospital, DK-8200 Aarhus N, Denmark
2Group-4 Falck Emergency Medical Service, Denmark
3Department of Medicine, Randers County Hospital, Randers, Denmark
4Department of Medicine, Silkeborg County Hospital, Silkeborg, Denmark
Received 2 September 2004; revised 4 November 2004; accepted 25 November 2004; online publish-ahead-of-print 31 January 2005.
* Corresponding author. Tel: +45 89496234; fax: +45 89496009. E-mail address: christian_juhl_terkelsen{at}hotmail.com
Aims The majority of patients with ST-elevation myocardial infarction (STEMI) are admitted to local hospitals without primary percutaneous coronary intervention (primary PCI) facilities. Acute transferral to an interventional centre is necessary to treat these patients with primary PCI. The present study assessed the reduction in treatment delay achieved by pre-hospital diagnosis and referral directly to an interventional centre.
Methods and results Two local hospitals without primary PCI facilities were serving the study region. Pre-hospital diagnoses were established with the use of telemedicine, by ambulance physicians, or by general practitioners. Primary PCI was accepted as the preferred reperfusion therapy in patients with STEMI. From 31 October 2002 to 31 January 2004 all patients transported by ambulance and transferred for primary PCI were registered. Patients with STEMI were divided into three groups: (A) patients diagnosed at a local hospital (n=55), (B) patients diagnosed pre-hospitally and admitted to a local hospital (n=85), and (C) patients diagnosed pre-hospitally and referred directly to the interventional centre (n=21). When comparing group A with group B and C, no difference was found in age, sex, infarct location, or distance from the scene of event to the interventional centre, whereas the median time from ambulance call to first balloon inflation was 41 min shorter in group B compared with group A (P<0.001) and 81 min shorter in group C compared with group A (P<0.001).
Conclusion In a cohort of patients scheduled for admission to a local hospital and subsequent transferral to an interventional centre for primary PCI, those diagnosed pre-hospitally had shorter treatment delay compared with those diagnosed in hospital, both in the setting of initial admission to a local hospital, and to an even larger extent in the setting of referral directly to the interventional centre.
Key Words: Myocardial infarction • Percutanous coronary intervention • Treatment delay • Pre-hospital diagnosis • Telemedicine
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