Coronary artery disease
Usefulness of Prehospital Triage in Patients With Cardiogenic Shock Complicating ST-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

https://doi.org/10.1016/j.amjcard.2007.03.099Get rights and content

We investigated the impact of ambulance-based prehospital triage on treatment delay and all-cause mortality (in hospital and long term) in patients with ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock referred for primary percutaneous coronary intervention in a prospectively collected registry. During the study period (January 2003 to December 2005), a total of 121 patients was referred for primary percutaneous coronary intervention at our intervention laboratory through 2 main triage groups: (1) after prehospital, ambulance-telemedicine–based triage (42 patients) and (2) by more conventional routes (79 patients) represented by the institutional S. Orsola-Malpighi hospital emergency department triage (44 patients) and spoke hospital triage (35 patients). Total ischemic time was shorter in the prehospital triage (142 minutes, range 106 to 187, vs 212 minutes, range 150 to 366, p = 0.003). Patients with prehospital triage showed a lower rate (29% vs 54%, p = 0.01) of severely depressed (≤35%) left ventricular systolic function and a 68% decrease in in-hospital mortality (9, 21%, vs 36, 46%, odds ratio 0.32, 95% confidence interval 0.14 to 0.77, p = 0.01). In the entire study population, patients revascularized within an optimal time (2 hours from symptom onset or 90 minutes from STEMI diagnosis) showed remarkably low in-hospital mortality (20% and 29%, respectively). At the 1-year follow-up, patients with prehospital triage had a higher survival rate (74% vs 52%, p = 0.019). In conclusion, this study indicates that prehospital triage with direct transportation to the intervention laboratory is associated with shorter treatment delay and better clinical outcome in patients with STEMI complicated by cardiogenic shock.

Section snippets

Setting and triages

In the Italian province of Bologna (3,702 km2, 950,000 inhabitants), systematic use of PCI for STEMI began in January 2003 in the context of the Propetto sull’ina mella Reprome Emilia Romagna (PRIMA RER) project set up by the Regione Emilia-Romagna.6 The province contains 2 centrally located PCI intervention laboratories (1 at S. Orsola-Malpighi hospital), which are available at short notice on a 24-hour basis, in addition to 10 peripheral hospitals without PCI facilities. Since June 2003, an

Results

A total of 121 patients with STEMI complicated by cardiogenic shock was referred to primary PCI at the S. Orsola-Malpighi interventional laboratory during the study period (January 2003 to December 2005). Of these, 42 were referred to our laboratory by the prehospital triage and 79 by the conventional triages. Table 1 lists baseline clinical characteristics, risk factors, and time delays of the 121 eligible patients according to PCI triage groups. Baseline clinical characteristics showed no

Discussion

The present observational study shows that in patients with cardiogenic shock, prehospital triage followed by direct transportation to the interventional laboratory can lead to a significant decrease in primary PCI treatment delay and suggests the hypothesis that a prehospital triage might provide in-hospital and long-term outcome benefit. The evidence that shorter treatment delay in patients undergoing primary PCI is associated with significant clinical improvement mainly in the sickest

References (15)

There are more references available in the full text version of this article.

Cited by (0)

This study was supported by the Fanti Melloni Foundation.

View full text