Abstract 2401: The Impact Of Ambulance-based Triage For Primary Angioplasty On Treatment Intervals And Clinical Outcome
Introduction: Ambulance-based triage for primary angioplasty has been shown to reduce treatment delays. The impact on clinical outcome has not been studied extensively.
Method: Consecutive patients who presented with STEMI (≥ 6mm) and who were referred for primary angioplasty to our intervention center in 2005 and 2006 were studied. Self-referred patients were excluded. Before transferral of the patient, the cath-lab was activated after consultation of our physician. Patients were referred either from the ambulance after prehospital diagnosis by trained paramedics or from a non-intervention center.
Results: In total 373 patients were referred, of whom 275 (74%) directly from the ambulance and 98 (26%) through a non-intervention center. Ambulance-triaged patients tended to be younger (62±12 vs. 65±14 yrs, p=0.06) and more often had a large (>15mm deviation) STEMI (62% vs. 50%, p=0.04). The median first-medical-contact-to-balloon time was significantly shorter after ambulance triage (63 min. (IQR:52– 80) vs. 100 min. (IQR:78–126), p<0.01). At a median follow-up of 270 days (IQR:144 – 483) survival of ambulance-triaged patients was higher (90% vs. 81%; log rank p=0.03). After adjusment for age and STEMI size, ambulance-triaged patients had improved survival HR 1.9 (95%CI: 1.1–3.4, p=0.03).
Conclusions: Ambulance-based triage for primary angioplasty with prehospital activation of the catheterization laboratory is associated with significantly shorter treatment delays as compared to referral through a non-intervention center. After adjustment for age and infarct size, ambulance triage was associated with improved long-term survival.