Abstract 2076: Western Sydney Emergency Triage of Acute Myocardial Infarction (ETAMI) Experience - Reduction in Time to Revascularisation, Improvement in LVEF and 30 day Mortality
INTRODUCTION: The ETAMI project is a collaboration between the NSW Ambulance Service, Northern and Western Sydney area Health Services. The aim is to provide pre-hospital triage of patients with chest pain to expedite revascularisation, by bypassing district hospitals with no angioplasty capability, and by early mobilisation of angioplasty teams.
METHODS: ETAMI-capable paramedics perform an ECG on initial assessment which is transmitted to the Regional Heart Centre (RHC ) and is interpreted by a Senior Emergency Physician. If the ECG meets criteria for primary angioplasty the ambulance is directed to the RHC, bypassing district hospitals, and the angioplasty team is mobilised.
RESULTS: During the first 18 months of the trial, the RHC in Western Sydney treated 297 patients with acute ST elevation myocardial infarction. We divided these patients into 3 groups: 69 presented to the RHC, 128 to the 3 district hospitals (DH), and 71 were triaged pre-hospital to the cardiac catheterisation laboratory using the ETAMI model. There was a median reduction in door to table time in the ETAMI group of 72 minutes compared to the DH patients, and 29 minutes compared to the RHC patients (p<0.001). Table to open artery (TIMI-3) times were similar. Left ventricular ejection fraction (LVEF) was measured by Gated Isotope Scanning at a mean of 4 days post infarct. The median LVEF was 53% in the ETAMI group, 51% in the RHC group and 47.5% in the DH group.
The 5.5% difference between the ETAMI and DH group was significant (p=0.015). There was a difference in all cause mortality at 30 days, with 8 deaths in the RHC group, 5 deaths in the DH group, and no deaths in the ETAMI group (p=0.038). There were no deaths in the ETAMI group during transportation and bypass of DH.
CONCLUSIONS: The ETAMI model is safe, reduces revascularisation times, preserves LV function, and improves 30 day mortality, in an Australian metropolitan population with RHC and DH structure.