Coronary artery diseaseUsefulness of Prehospital Triage in Patients With Cardiogenic Shock Complicating ST-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention
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
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This study was supported by the Fanti Melloni Foundation.