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European Heart Journal Advance Access originally published online on August 1, 2007
European Heart Journal 2007 28(19):2313-2319; doi:10.1093/eurheartj/ehm306
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Field triage to primary angioplasty combined with emergency department bypass reduces treatment delays and is associated with improved outcome

Steen Carstensen1,*, Greg C.I. Nelson1, Peter S. Hansen1, Lewis Macken2, Stephen Irons3, Michael Flynn3, Pramesh Kovoor4, Soon Y. Soo Hoo1, Michael R. Ward1 and Helge H. Rasmussen1

1 Department of Cardiology, Royal North Shore Hospital, University of Sydney, Australia
2 Emergency Department, Royal North Shore Hospital, University of Sydney, Australia
3 Ambulance Service of New South Wales, Sydney, Australia
4 Department of Cardiology, Westmead Hospital, University of Sydney, Australia

Received 26 September 2006; revised 1 June 2007; accepted 21 June 2007; online publish-ahead-of-print 1 August 2007.

* Corresponding author: Department of Cardiology, Roskilde Hospital, University of Copenhagen, DK-4000 Roskilde, Denmark. Tel: +45 30502589; fax: +45 46362797. E-mail address: sc{at}dadlnet.dk

Aims: We investigated the net benefit in the outcome of reducing treatment delay through field triage and emergency department (ED) bypass in patients with ST-elevation myocardial infarction (STEMI) treated with primary angioplasty.

Methods and results: In a prospective registry study, consecutive patients with suspected STEMI were assigned to: (i) pre-hospital ECG and triage or (ii) ECG and triage at the closest ED, solely based on ambulance availability. Four district hospitals and one regional heart centre serviced the 890 000 population metropolitan area and primary angioplasty was the only reperfusion strategy employed. Baseline characteristics were similar in STEMI patients triaged in the field (108) and the EDs (193). Symptom onset to balloon times: 154 [inter-quartile range (IQR) 120–233) vs. 249 (IQR 184–405) min (P < 0.001) and peak creatine kinase in early presenters (<2 h): 1435 (95 %CI: 904–1966) U/L vs. 2320 (95% CI: 1881–2762) U/L (P = 0.009) were lower in field- than in ED-triaged patients. Mortality in the PCI treated were 1.1 and 8.2% [P = 0.025, RR 0.14 (95% CI: 0.01–1.08)] and overall mortality were 1.9 and 7.3% [P = 0.046, RR 0.26 (95% CI: 0.05–1.11)].

Conclusion: Field-triage and ED bypass were feasible means of reducing treatment delay in patients with suspected STEMI and resulted in smaller infarct size in early presenters and a trend towards a reduction in mortality.

Key Words: Myocardial infarction • Treatment pathway • Primary angioplasty • Mortality


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