Abstract 2400: Western Sydney Emergency Triage of Acute Myocardial Infarction (ETAMI) experience - effect of pre-hospital triage on 12 month mortality
Introduction: The aim of the ETAMI project is to provide pre-hospital triage of patients with chest pain, to bypass district hospitals, and expedite percutaneous revascularisation.
Hypothesis: In this study we assessed the effect of prehospital triage on revascularisation times, left ventricular function, 30 day and 12 month mortality, in an Australian urban population.
Methods and Results: During the first 30 months of the trial, the Regional Heart Centre (RHC) in Western Sydney treated 566 patients with acute ST elevation myocardial infarction. We divided these patients into 3 groups: 180 presented to the RHC, 239 to the 3 district hospitals (DH), and 147 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 71 minutes compared to the DH patients, and 31 minutes compared to the RHC patients (p<0.01). 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 LVEF (%) was 52 ± 12 in the ETAMI group, 51 ± 13 in the RHC group, and 48 ± 11 in the DH group (p=0.08). There was a difference in all cause mortality at 30 days, with 15 deaths in the RHC group, 9 deaths in the DH group, and 4 deaths in the ETAMI group (p=0.036). At 6 months follow up there were a total of 17 deaths in the RHC group, 11 deaths in the DH group, and 4 deaths in the ETAMI group (p=0.05). At 12 months follow up, there were18 deaths in the RHC group, 11 deaths in the DH group, and 7 deaths in the ETAMI group (p= 0.13). The combined 12 month mortality for the 3 groups was 11,5%.
Conclusions: In conclusion, field triage is safe, reduces revascularisation times, improves LV function, and shows an improved mortality rate at 30 days.This survival advantage continues at 6 months, but did not extend to 12 months.