Field triage to primary angioplasty combined with emergency department bypass reduces treatment delays and is associated with improved outcome.
OBJECTIVE
We investigated the net benefit in the outcome of reducing treatment delay through field triage and emergency department (ED) bypass in patients with ST-elevation myocardial infarction (STEMI) treated with primary angioplasty.


RESULTS
In a prospective registry study, consecutive patients with suspected STEMI were assigned to: (i) pre-hospital ECG and triage or (ii) ECG and triage at the closest ED, solely based on ambulance availability. Four district hospitals and one regional heart centre serviced the 890,000 population metropolitan area and primary angioplasty was the only reperfusion strategy employed. Baseline characteristics were similar in STEMI patients triaged in the field (108) and the EDs (193). Symptom onset to balloon times: 154 [inter-quartile range (IQR) 120-233) vs. 249 (IQR 184-405) min (P<0.001) and peak creatine kinase in early presenters (<2 h): 1435 (95 %CI: 904-1966) U/L vs. 2320 (95% CI: 1881-2762) U/L (P=0.009) were lower in field- than in ED-triaged patients. Mortality in the PCI treated were 1.1 and 8.2% [P=0.025, RR 0.14 (95% CI: 0.01-1.08)] and overall mortality were 1.9 and 7.3% [P=0.046, RR 0.26 (95% CI: 0.05-1.11)].


CONCLUSIONS
Field-triage and ED bypass were feasible means of reducing treatment delay in patients with suspected STEMI and resulted in smaller infarct size in early presenters and a trend towards a reduction in mortality.
Department of Cardiology, Royal North Shore Hospital, University of Sydney, Australia. sc@dadlnet.dk
Steen
S
Carstensen
Greg C I
GC
Nelson
Peter S
PS
Hansen
Lewis
L
Macken
Stephen
S
Irons
Michael
M
Flynn
Pramesh
P
Kovoor
Soon Y
SY
Soo Hoo
Michael R
MR
Ward
Helge H
HH
Rasmussen
D000368:Aged; D000552:Ambulances; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality; D017023:Coronary Angiography; D004562:Electrocardiography; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014218:Triage / Q000458:organization & administration*