Abstract 4076: Pre-hospital Recognition of STEMI in WEST: an Opportunity Not to be Denied
Background: Prompt reperfusion therapy in ST elevation myocardial infarction enhances clinical outcomes. Treatment delay is a major impediment to best care and arrival by ambulance is advantageous. However, little information exists regarding treatment times and how STEMI patients are transported.
Methods: In the Which Early ST Elevation Myocardial infarction Treatment (WEST) study, treatment of STEMI pts was started at earliest point of medical contact. Treatment arms were TNK with routine clinical care; TNK with mandated rescue PCI or angiography within 24 hours; and primary PCI. Pre-hospital randomization and ambulance treatment was a key study aspect. Hence we assessed how differing transport modes influenced patient treatment times. Groups compared included pts randomized and treated pre-hospital, pts presenting directly to hospital by mode other than ambulance, and those presenting to hospital by non-randomizing ambulance. For ambulance pts, first medical contact was determined by assessment by pre-hospital personnel.
Results: The table⇓ shows median times in minutes for 1st medical contact to 1st study drug for fibrinolytic treated and PCI pts (and for medical contact to balloon) according to which of the 3 transport modes were used prior to study entry.
Conclusions: These data highlight that a clinical trial environment with heightened awareness for STEMI may obviate the expected delay in treatment times amongst those “In-hospital: non-ambulance” arrival pts. STEMI pts presenting by ambulance without pre-hospital randomization and treatment exhibited substantial delay from 1st medical contact. The time from first medical contact in the “In-hospital: ambulance” pts did not afford the advantage seen in “Pre-hospital” pts, further emphasizing the need to enhance pre-hospital process of care. Patients undergoing direct PCI appear to have the best opportunity to reduce time to treatment through pre-hospital recognition.