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European Heart Journal Advance Access published online on May 17, 2006
European Heart Journal, doi:10.1093/eurheartj/ehl006
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European Heart Journal © The European Society of Cardiology 2006; all rights reserved
Received November 23, 2005
Revised March 27, 2006
Accepted April 6, 2006

Clinical research

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

Paolo Ortolani 1 *, Antonio Marzocchi 1, Cinzia Marrozzini 1, Tullio Palmerini 1, Francesco Saia 1, Carlo Serantoni 2, Matteo Aquilina 1, Simona Silenzi 1, Federica Baldazzi 1, Daniele Grosseto 1, Nevio Taglieri 1, Robin M.T. Cooke 1, Maria Letizia Bacchi-Reggiani 1, and Angelo Branzi 1

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

* To whom correspondence should be addressed.
Paolo Ortolani, E-mail: paortol{at}tin.it


  Abstract

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.

Keywords: Myocardial infarction; Angioplasty; Transluminal; Percutaneous coronary; Shock.
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