title: Lower mortality after prehospital recognition and treatment followed by fast tracking to coronary care compared with admittance via emergency department in patients with ST-elevation myocardial infarction.
abstract: OBJECTIVE
  To describe the short-and long-term outcome among patients with an ST-elevation myocardial infarction (STEMI), assessed and treated by the emergency medical services (EMS) in relation to whether they were fast tracked to a coronary care unit (CCU) or admitted via the emergency department (ED).
  
  
  METHODS
  Consecutive patients admitted to the CCU at Sahlgrenska University Hospital with ST elevations on admission ECG were analysed with respect to whether they by the EMS were fast tracked to the CCU or the adjacent coronary angiography laboratory (direct CCU group; n=261) or admitted via the ED (ED group; n=235).
  
  
  RESULTS
  Whereas the two groups were similar with regard to age and previous history, those who were fast tracked to CCU were more frequently than the ED patients diagnosed and treated as STEMI already prior to hospital admission. Reperfusion therapy was more commonly applied in the CCU group compared with the ED group (90% vs 67%; <0.0001). The delay times (median) were shorter in the direct CCU group than in the ED group, with a difference of 10 min from the onset of symptoms to arrival in hospital and 25 min from hospital arrival to the start of reperfusion treatment (primary PCI or in-hospital fibrinolysis). Patients in the direct CCU group had lower 30-day mortality (7.3% vs. 15.3%; p=0.004), as well as late mortality (>30 days to five years) (11.6% vs. 20.6%; p=0.008).
  
  
  CONCLUSIONS
  Among patients transported with ambulance due to STEMI there was a significant association between early recognition and treatment followed by fast tracking to the CCU and long term survival. A higher rate of and a more rapid revascularisation were probably of significant importance for the outcome.
authors.affiliation: Prehospital Research Centre, University Collage of Borås, Borås, Sweden.
authors.forename: Angela
authors.initials: A
authors.lastname: Bång
authors.forename: Lars
authors.initials: L
authors.lastname: Grip
authors.forename: Johan
authors.initials: J
authors.lastname: Herlitz
authors.forename: Stefan
authors.initials: S
authors.lastname: Kihlgren
authors.forename: Thomas
authors.initials: T
authors.lastname: Karlsson
authors.forename: Kenneth
authors.initials: K
authors.lastname: Caidahl
authors.forename: Marianne
authors.initials: M
authors.lastname: Hartford
mesh_terms: D000368:Aged; D003325:Coronary Care Units / Q000379:methods* / Q000639:trends; D004632:Emergency Medical Services / Q000379:methods* / Q000639:trends; D004636:Emergency Service, Hospital / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D010343:Patient Admission / Q000639:trends; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome