Abstract 4544: Field Triage Reduces Treatment Delay and Improves Long-Term Clinical Outcome in Patients With Acute STEMI Treated With Primary PCI
Objectives and Background: Reduction of treatment delay is crucial for patients with ST-segment elevation myocardial infarction (STEMI). We evaluated the independent impact of field triage on treatment delay and long-term clinical outcome in a large contemporary, consecutive population of STEMI patients undergoing primary percutaneous coronary intervention (pPCI).
Methods: From January 2005 to July 2008, 1,437 STEMI patients were treated with pPCI at a single high volume invasive center. Median follow-up time was 365 days in this observational registry study.
Results: A total of 616 patients were admitted by field triage and 821 by emergency departments. Baseline- and angiographic variables were similar in the two populations. Patients admitted by field triage had a significantly shorter median door-to-balloon time compared to patients admitted by emergency department triage (83 minutes; IQR: 67–100 vs. 103 minutes; 80 –135; P<0.001). Door-to-balloon times of less than the recommended 90 minutes were achieved in 61% of field triage patients, but only in 36% of non-field triage patients (P<0.001). At the end of follow-up, a total of 9.1% in the field triage group versus 13.0% in the non-field triage group reached the combined end-point of all-cause mortality or non-fatal MI (P=0.02). After adjustment for relevant baseline variables, patients admitted by field triage had reduced risk of reaching the combined end-point of all cause mortality or non-fatal MI: Hazard Ratio 0.67; 95% confidence interval 0.46 – 0.97; P=0.035).
Conclusions: This study shows that field triage of STEMI-patients to pPCI, significantly reduces treatment delay and improves outcome. This suggests that field triage - if possible - should be implemented in areas where pPCI is the treatment of choice for STEMI patients.