title: Reduction of treatment delay in patients with ST-elevation myocardial infarction: impact of pre-hospital diagnosis and direct referral to primary percutanous coronary intervention.
abstract: OBJECTIVE
  The majority of patients with ST-elevation myocardial infarction (STEMI) are admitted to local hospitals without primary percutaneous coronary intervention (primary PCI) facilities. Acute transferral to an interventional centre is necessary to treat these patients with primary PCI. The present study assessed the reduction in treatment delay achieved by pre-hospital diagnosis and referral directly to an interventional centre.
  
  
  RESULTS
  Two local hospitals without primary PCI facilities were serving the study region. Pre-hospital diagnoses were established with the use of telemedicine, by ambulance physicians, or by general practitioners. Primary PCI was accepted as the preferred reperfusion therapy in patients with STEMI. From 31 October 2002 to 31 January 2004 all patients transported by ambulance and transferred for primary PCI were registered. Patients with STEMI were divided into three groups: (A) patients diagnosed at a local hospital (n = 55), (B) patients diagnosed pre-hospitally and admitted to a local hospital (n = 85), and (C) patients diagnosed pre-hospitally and referred directly to the interventional centre (n = 21). When comparing group A with group B and C, no difference was found in age, sex, infarct location, or distance from the scene of event to the interventional centre, whereas the median time from ambulance call to first balloon inflation was 41 min shorter in group B compared with group A (P<0.001) and 81 min shorter in group C compared with group A (P<0.001).
  
  
  CONCLUSIONS
  In a cohort of patients scheduled for admission to a local hospital and subsequent transferral to an interventional centre for primary PCI, those diagnosed pre-hospitally had shorter treatment delay compared with those diagnosed in hospital, both in the setting of initial admission to a local hospital, and to an even larger extent in the setting of referral directly to the interventional centre.
authors.affiliation: Department of Cardiology, Skejby University Hospital, DK-8200 Aarhus N, Denmark. christian_juhl_terkelsen@hotmail.com
authors.forename: Christian Juhl
authors.initials: CJ
authors.lastname: Terkelsen
authors.forename: Jens Flensted
authors.initials: JF
authors.lastname: Lassen
authors.forename: Bjarne Linde
authors.initials: BL
authors.lastname: Nørgaard
authors.forename: Jens Christian
authors.initials: JC
authors.lastname: Gerdes
authors.forename: Steen Hvitfeldt
authors.initials: SH
authors.lastname: Poulsen
authors.forename: Kristoffer
authors.initials: K
authors.lastname: Bendix
authors.forename: Jens Peter
authors.initials: JP
authors.lastname: Ankersen
authors.forename: Liv Bjørn-Hansen
authors.initials: LB
authors.lastname: Gøtzsche
authors.forename: Frode Kirketerp
authors.initials: FK
authors.lastname: Rømer
authors.forename: Torsten Toftegaard
authors.initials: TT
authors.lastname: Nielsen
authors.forename: Henning Rud
authors.initials: HR
authors.lastname: Andersen
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015331:Cohort Studies; D042241:Early Diagnosis; D004562:Electrocardiography; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy; D012017:Referral and Consultation