title: Impact of prehospital diagnosis in the management of ST elevation myocardial infarction in the era of primary percutaneous coronary intervention: reduction of treatment delay and mortality.
abstract: OBJECTIVE
  The aim of the study is to assess, as primary endpoints, in-hospital mortality and percutaneous coronary intervention (PCI) mortality and to compare the outcome in ST elevation myocardial infarction (STEMI) patients with different pathways to a catheterization laboratory in the context of an area with 24 h availability of catheter facilities.
  
  
  METHODS
  Three hundred and ninety-nine STEMI patients, referred to an interventional centre for primary PCI, were divided into two groups according to the different pathways to the catheterization laboratory. Group A had 263 patients diagnosed following admission to First Aid. Group B had 136 patients diagnosed in a prehospital setting with telemedicine equipment and transferred directly to the interventional centre by advanced life support (ALS) ambulance.
  
  
  RESULTS
  Significantly shorter treatment delay was observed in group B patients than in group A (262 +/- 112 vs. 148 +/- 81 min in group A vs. B, P < 0.001). A significant reduction in total mortality was observed in group B compared with group A (8.7 vs. 3% in group A vs. B, P < 0.05). After multivariate analysis, predictors of in-hospital mortality are age and Killip class (P < 0.01), different pathways to catheterization laboratory, pre-PCI TIMI flow and onset-to-balloon time (P < 0.05).
  
  
  CONCLUSIONS
  The present study shows a reduction in treatment delay and in-hospital mortality by prehospital ECG and direct referral to catheterization laboratory.
authors.affiliation: Department of Cardiology, Mantova City Hospital Carlo Poma, Mantova, Italy. cardiomantova@virgilio.it
authors.forename: Roberto
authors.initials: R
authors.lastname: Zanini
authors.forename: Marco
authors.initials: M
authors.lastname: Aroldi
authors.forename: Silvia
authors.initials: S
authors.lastname: Bonatti
authors.forename: Francesca
authors.initials: F
authors.lastname: Buffoli
authors.forename: Antonio
authors.initials: A
authors.lastname: Izzo
authors.forename: Corrado
authors.initials: C
authors.lastname: Lettieri
authors.forename: Michele
authors.initials: M
authors.lastname: Romano
authors.forename: Luca
authors.initials: L
authors.lastname: Tomasi
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: Ferrari
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D006328:Cardiac Catheterization; D004562:Electrocardiography; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology*; D013997:Time Factors