Clinical impact of direct referral to primary percutaneous coronary intervention following pre-hospital diagnosis of ST-elevation myocardial infarction.
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.
Ortolani
Paolo
P
Institute of Cardiology, Azienda Ospedaliera S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy. paortol@tin.it
Marzocchi
Antonio
A
Marrozzini
Cinzia
C
Palmerini
Tullio
T
Saia
Francesco
F
Serantoni
Carlo
C
Aquilina
Matteo
M
Silenzi
Simona
S
Baldazzi
Federica
F
Grosseto
Daniele
D
Taglieri
Nevio
N
Cooke
Robin M T
RM
Bacchi-Reggiani
Maria Letizia
ML
Branzi
Angelo
A
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