title: Effect of prehospital triage on revascularization times, left ventricular function, and survival in patients with ST-elevation myocardial infarction.
abstract: Shorter reperfusion times lead to better outcomes in patients with ST-elevation myocardial infarction (STEMI). We assessed the efficacy of prehospital triage with bypass of community hospitals and early activation of the cardiac catheterization team on revascularization times, left ventricular (LV) ejection fraction, and survival. Patients with STEMI (624) were divided into 3 groups determined by site of triage: ambulance field triage (163), interventional center emergency department (202), and 3 community hospital emergency departments (259). Compared with community hospital and interventional center triages, ambulance field triage resulted in a significant median decrease in door-to-balloon times of 68 and 27 minutes, respectively (p <0.001). LV ejection fraction was highest in the field triage group (52 +/- 13%) compared with the interventional center (49 +/- 12%) and community hospital (48 +/- 12%, p = 0.017) groups. Thirty-day mortality was lowest in the ambulance field group (3%) compared with the interventional facility (11%) and community hospital (4%, p = 0.007) groups. There was a significant difference in long-term survival with up to 30-month follow-up among the 3 triage groups (p = 0.041). With time-dependent Cox regression modeling the difference in survival was significant only during the first week after STEMI (p = 0.020). Every extra minute of symptom onset to reperfusion time was associated with a relative risk of long-term mortality of 1.003 (95% confidence interval 1.000 to 1.006, p = 0.027). In conclusion, field triage of patient with STEMI decreased revascularization times, which preserved LV function, and improved early survival.
authors.affiliation: Cardiology Department, Westmead Hospital, Westmead, NSW, Australia.
authors.forename: Gopal
authors.initials: G
authors.lastname: Sivagangabalan
authors.forename: Andrew T L
authors.initials: AT
authors.lastname: Ong
authors.forename: Arun
authors.initials: A
authors.lastname: Narayan
authors.forename: Norman
authors.initials: N
authors.lastname: Sadick
authors.forename: Peter S
authors.initials: PS
authors.lastname: Hansen
authors.forename: Greg C I
authors.initials: GC
authors.lastname: Nelson
authors.forename: Michael
authors.initials: M
authors.lastname: Flynn
authors.forename: David L
authors.initials: DL
authors.lastname: Ross
authors.forename: Steven C
authors.initials: SC
authors.lastname: Boyages
authors.forename: Pramesh
authors.initials: P
authors.lastname: Kovoor