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European Heart Journal Advance Access originally published online on May 17, 2006
European Heart Journal 2006 27(13):1550-1557; doi:10.1093/eurheartj/ehl006
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Clinical impact of direct referral to primary percutaneous coronary intervention following pre-hospital diagnosis of ST-elevation myocardial infarction

Paolo Ortolani1,*, Antonio Marzocchi1, Cinzia Marrozzini1, Tullio Palmerini1, Francesco Saia1, Carlo Serantoni2, Matteo Aquilina1, Simona Silenzi1, Federica Baldazzi1, Daniele Grosseto1, Nevio Taglieri1, Robin M.T. Cooke1, Maria Letizia Bacchi-Reggiani1 and Angelo Branzi1

1 Institute of Cardiology, Azienda Ospedaliera S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
2 118 Emergency Medical Service, Maggiore Hospital, Bologna, Italy

Received 23 November 2005; revised 27 March 2006; accepted 6 April 2006; online publish-ahead-of-print 17 May 2006.

* Corresponding author. Tel: +39 (0) 516364477; fax: +39 (0) 51344859. E-mail address: paortol{at}tin.it

See page 1515 for the editorial comment on this article (doi:10.1093/eurheartj/ehl064)

Aims Treatment delay is a powerful predictor of survival in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). We investigated effectiveness of pre-hospital diagnosis of STEMI with direct referral to PCI, alongside more conventional referral strategies.

Methods and results From January 2003 to December 2004, 658 STEMI patients were referred for primary PCI at our intervention laboratory. Three predefined referral routes were compared: (1) for patients within 90 min drive of the PCI centre, pre-hospital diagnosis and direct transportation (n=166), (2) diagnosis at the interventional hospital emergency department (n=316), (3) diagnosis at local hospitals before transportation (n=176). Pre-hospital diagnosis was associated with more than 45 min reduction in treatment delay (P=0.001). No significant difference in in-hospital mortality was apparent in the overall study population. In the cardiogenic shock subgroup (n=80), pre-hospital diagnosis was associated with a two-thirds reduction in in-hospital mortality (P=0.019); mortality was only 6.2% in shock patients who underwent PCI in <2 h.

Conclusion This study shows that pre-hospital diagnosis can provide a reduction in primary PCI treatment delay, and suggests the hypothesis that this referral strategy might provide survival benefits to patients with cardiogenic shock.

Key Words: Myocardial infarction • Angioplasty • Transluminal • Percutaneous coronary • Shock


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