[Interhospital transport of acute coronary syndrome patients from Bács-Kiskun county].
BACKGROUND
As an alternative to thrombolysis, primary percutaneous coronary intervention is increasingly utilized in Hungary for treating acute ST elevation myocardial infarction. Heart catheterization laboratories however are not readily available in vast areas of the country. The benefits of primary intervention may fade away with long distance transportation.


METHODS
In order to assess real life practice, the authors have retrospectively studied the interhospital delays of patients transferred with acute coronary syndromes from Bács-Kiskun county between April 2000 and March 2003. This is the largest county of Hungary, with population of 570,000, with no local hemodynamic laboratory. Patients with acute coronary syndromes are transferred to the Cardiac Centers of the Universities of Szeged and Pécs, as well as to 3 designated hospitals with heart catheterization facilities at Budapest. Interhospital delay was defined as the time elapsed from the call of the Emergency Medical Service to the admission of the patient to the catheterization laboratory.


RESULTS
During the studied period 94 patients were transported with acute coronary syndrome. In 79 cases the complete medical documentation from the primary hospitals and the hemodynamic laboratories could be collected. 17 patients with ST-elevation were transported for primary intervention. Twenty-six patient received both thrombolytic and interventional therapy. Further 36 patients suffered from non ST elevation myocardial infarction or unstable angina. Interhospital delay for the whole group was 166 +/- 55 minutes, and for the subgroup of ST-elevation patients awaiting for primary intervention 148 +/- 43 minutes. The transfer time, i.e. the time that the patient spent on the road or in the air lasted longer than 90 minutes in 80% of cases. Air transportation resulted in no reduction of transport time. This finding may be explained by the fact, that both the sending and receiving hospitals lack appropriate helicopter landing sites.


CONCLUSIONS
The authors conclude, that for those residents of Bács-Kiskun county who suffer from acute ST-elevation myocardial infarction, and have no contraindications for thrombolysis, primary intervention is not a viable therapeutic option.
Burány
Béla
B
Országos Mentoszolgálat Foigazgatósága, Szervezési és Módszertani Osztály, Budapest. burany@monornet.hu
Rudas
László
L
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization; D003327:Coronary Disease / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D004632:Emergency Medical Services; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D006814:Hungary; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D010343:Patient Admission; D010360:Patient Transfer; D012189:Retrospective Studies; D015912:Thrombolytic Therapy