Abstract 11100: Urban and Rural Implementation of Prehospital Diagnosis and Direct Referral for Primary PCI in Patients with Acute ST-elevation Myocardial Infarction
Background: Primary PCI is a superior treatment for ST elevation myocardial infarction (STEMI). The distance to primary PCI centers and the inherent time delay in delivering primary PCI, however, limit widespread application of this treatment. This study aims to evaluate the impact of prehospital diagnosis on time from emergency medical services contact to balloon inflation (system delay) and mortality in an unselected cohort of STEMI patients recruited from a large geographical area comprising both urban and rural districts.
Methods: From February 2004 until January 2007 data on prehospital timing and transport distance were prospectively recorded. Patients were divided into groups depending on whether prehospital diagnosis and direct referral to a primary PCI center were performed.
Results: 759 consecutive STEMI patients were included. In patients with a prehospital diagnosis and direct referral, the system delay was 92 minutes vs. 153 minutes in patients without prehospital diagnosis (p<0.001). Patients from rural areas were transported a median of 30 km longer than patients from urban areas; however, this prolonged the system delay by only 9 minutes. Long-term mortality was significantly lower in patients with prehospital diagnosis and direct referral compared with patients without prehospital diagnosis (18% vs. 31%, log-rank p=0.003).
Conclusions: Prehospital ECG diagnosis and direct referral for primary PCI is associated with lower mortality and enables STEMI patients living far from a PCI center to achieve a system delay comparable to patients living in close vicinity of a PCI center.
- © 2010 by American Heart Association, Inc.