title: Clinical impact of direct referral to primary percutaneous coronary intervention following pre-hospital diagnosis of ST-elevation myocardial infarction.
abstract: OBJECTIVE
  Treatment delay is a powerful predictor of survival in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). We investigated effectiveness of pre-hospital diagnosis of STEMI with direct referral to PCI, alongside more conventional referral strategies.
  
  
  RESULTS
  From January 2003 to December 2004, 658 STEMI patients were referred for primary PCI at our intervention laboratory. Three predefined referral routes were compared: (1) for patients within 90 min drive of the PCI centre, pre-hospital diagnosis and direct transportation (n=166), (2) diagnosis at the interventional hospital emergency department (n=316), (3) diagnosis at local hospitals before transportation (n = 176). Pre-hospital diagnosis was associated with more than 45 min reduction in treatment delay (P = 0.001). No significant difference in in-hospital mortality was apparent in the overall study population. In the cardiogenic shock subgroup (n = 80), pre-hospital diagnosis was associated with a two-thirds reduction in in-hospital mortality (P = 0.019); mortality was only 6.2% in shock patients who underwent PCI in < 2 h.
  
  
  CONCLUSIONS
  This study shows that pre-hospital diagnosis can provide a reduction in primary PCI treatment delay, and suggests the hypothesis that this referral strategy might provide survival benefits to patients with cardiogenic shock.
authors.affiliation: Institute of Cardiology, Azienda Ospedaliera S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy. paortol@tin.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Ortolani
authors.forename: Antonio
authors.initials: A
authors.lastname: Marzocchi
authors.forename: Cinzia
authors.initials: C
authors.lastname: Marrozzini
authors.forename: Tullio
authors.initials: T
authors.lastname: Palmerini
authors.forename: Francesco
authors.initials: F
authors.lastname: Saia
authors.forename: Carlo
authors.initials: C
authors.lastname: Serantoni
authors.forename: Matteo
authors.initials: M
authors.lastname: Aquilina
authors.forename: Simona
authors.initials: S
authors.lastname: Silenzi
authors.forename: Federica
authors.initials: F
authors.lastname: Baldazzi
authors.forename: Daniele
authors.initials: D
authors.lastname: Grosseto
authors.forename: Nevio
authors.initials: N
authors.lastname: Taglieri
authors.forename: Robin M T
authors.initials: RM
authors.lastname: Cooke
authors.forename: Maria Letizia
authors.initials: ML
authors.lastname: Bacchi-Reggiani
authors.forename: Angelo
authors.initials: A
authors.lastname: Branzi
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D042241:Early Diagnosis; D004632:Emergency Medical Services / Q000458:organization & administration; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D011446:Prospective Studies; D012017:Referral and Consultation; D016896:Treatment Outcome