In-hospital delay in ST-segment-elevation myocardial infarction after Manchester Triage.
BACKGROUND
In ST-segment elevation myocardial infarction (STEMI), time to reperfusion influences morbidity and mortality, and reducing in-hospital delay (IHD) continues to be important. Doubts have been expressed whether the Manchester Triage System (MTS) contributes to this objective.


OBJECTIVE
To evaluate the effectiveness of the MTS in classifying STEMI patients and its effect on IHD.


METHODS
We analyzed 278 patients with STEMI admitted to the Coronary Care Unit through the Emergency Department between January 13 2005 and November 26 2006. The patients were divided into two groups according to their MTS classification: Group A--emergent and very urgent patients; Group B--urgent and standard patients. The two groups were compared in terms of clinical and demographic characteristics, pre-hospital delay (PHD), IHD and door-to-needle (DNT) and door-to-balloon (DBT) times.


RESULTS
The mean age of the patients studied was 68 +/- 14 years, and 184 patients (65.7%) were male. Group A comprised 220 patients (79%) and Group B 58 patients (21%). There were no significant differences between the two groups in clinical or demographic characteristics or in PHD. IHD, DNT and DBT were significantly longer in Group B.


CONCLUSIONS
1) Although the majority of STEMI patients were classified as emergent or very urgent, the percentage not classified as such by the MTS was excessively high. 2) This could not be explained by clinical characteristics or by PHD. 3) The incorrect classification by the MTS of patients with STEMI resulted in significantly increased IHD in a large proportion of patients, limiting prompt access to reperfusion therapy.
Trigo
Joana
J
Serviço de Cardiologia, Hospital Central de Faro, Faro, Portugal. jotrigo@gmail.com
Gago
Paula
P
Mimoso
Jorge
J
Santos
Walter
W
Marques
Nuno
N
Gomes
Veloso
V
D000368:Aged; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000145:classification* / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D014218:Triage