Abstract 13: Prehospital Treatment Improves 1-Year Survival of Patients with Acute Myocardial Infarction with ST Segment Elevation
Our objective is to analyse the prehospital treatment and 1-year survival of patients with acute myocardial infarction with ST segment elevation (STEMI) cared for emergency teams.
Methods: Prospective cohort study of a continuous prehospital registry of patients cared for and diagnosed with STEMI by prehospital emergency teams in Andalusia (Spain). Jan-2001/Dec-2003.
Results: Patients included: 2572. Male 1956 (76%). Mean age: 64.4 ± 13.4 years(62±13 for men and 71,8±12 for women). First coronary event:1639 (63,7%). Killip class I: 2217 (86.2%). General measures: aspirine administration 2273 (88.4%), Nitroglycerine 2178 (84,7%) and morphine 1862 (72,4%). Eligible patients for fibrinolysis therapy: 2047 (79,6%), prehospital fibrinolysis (PHF) was performed on 474 (23.15%). The median of time from onset symptoms-PHF was 100 min. The rate of PHF performed in the first hour was 20,7% and 68% in the first 2 h. Haemorrhagic strokes post-PHF in 2 (0.4%) patients. Ventricular Fibrillation (VF) in 161 (6.3%) patients of which 107 (66.7%) were alive at hospital discharge. Initial mortality (pre and in-hospital mortality): 403 (15.7%) patients, 26 (1%) in the prehospital setting. Mortality within the first year was 564 (24.8%), of which 230 (40.8%) died within the first 24 hours. Clinical variables associated with 1-year survival in the table⇓.
Conclusions: Older patients, women patients and clinical variables such as hypotension, tachycardia, Killip class>1 and VF are associated with higher mortality. Reperfusion therapies, especially PHF, followed by PCI during hospital admission, are associated with higher rates of 1-year survival. Prehospital treatment of patients with STEMI reduces mortality