title: Implementation of guidelines for the treatment of acute ST-elevation myocardial infarction: the Cologne Infarction Model Registry.
abstract: BACKGROUND
  The aim of the Köln (Cologne) Infarction Model is to examine the feasibility of obligatory treatment of ST-segment-elevation myocardial infarction (STEMI) by first-line percutaneous coronary intervention.
  
  
  RESULTS
  The study was performed in Cologne with >1 million citizens, 5 coronary intervention centers, and 11 primary care hospitals. Twelve-lead ECG was available for all emergency medical service (EMS) teams. Partners guaranteed direct transfer of STEMI patients to a catheterization laboratory. A total of 519 patients treated within KIM in 2006 were included in the study. Of these, 24% presented at a primary care hospital, 11% presented directly at a coronary intervention center, 5% were transferred by EMS to primary care hospitals, and 60% were directly transferred by EMS to a catheterization laboratory. In 91% of cases, the catheterization laboratory was notified of the patient's arrival in advance. False-positive ECG diagnosis of STEMI by EMS accounted for 6%. Median treatment times were as follows: from the start of symptoms to first medical contact, 120 minutes; phone to balloon, 70 minutes; and door to balloon, 49 minutes. Of all patients, 93% underwent angiography; 409 patients were treated by coronary intervention, and 24 underwent emergency coronary artery bypass graft. Thrombolysis in Myocardial Infarction grade 3 flow was obtained in 89%. In the hospitals, deaths and new myocardial infarctions were observed in 12.1% and in 1.9% of all patients, respectively.
  
  
  CONCLUSIONS
  The Cologne Infarction Model provides evidence for the feasibility of obligatory treatment of STEMI by primary coronary intervention in a metropolitan setting. Acceptance of treatment pathways allowed nearly all STEMI patients to undergo coronary angiography. ECG competence of EMS was excellent. Treatment times were within postulated limits. Results, including mortality, were within a high quality range.
authors.affiliation: Klinik III für Innere Medizin, Universitaet zu Koeln, Kerpener Strasse 62, 50937 Cologne, Germany. markus.flesch@uni-koeln.de
authors.forename: Markus
authors.initials: M
authors.lastname: Flesch
authors.forename: Jens
authors.initials: J
authors.lastname: Hagemeister
authors.forename: Hans-Joerg
authors.initials: HJ
authors.lastname: Berger
authors.forename: Annett
authors.initials: A
authors.lastname: Schiefer
authors.forename: Sylke
authors.initials: S
authors.lastname: Schynkowski
authors.forename: Martin
authors.initials: M
authors.lastname: Klein
authors.forename: Sassan
authors.initials: S
authors.lastname: Sahebdjami
authors.forename: Stephan
authors.initials: S
authors.lastname: vom Dahl
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Fehske
authors.forename: Rudolf
authors.initials: R
authors.lastname: Mies
authors.forename: Michael
authors.initials: M
authors.lastname: von Eiff
authors.forename: Holger
authors.initials: H
authors.lastname: Pfaff
authors.forename: Peter
authors.initials: P
authors.lastname: Frommolt
authors.forename: Hans-Wilhelm
authors.initials: HW
authors.lastname: Hoepp
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D003331:Coronary Vessels / Q000601:surgery*; D003951:Diagnostic Errors; D004562:Electrocardiography; D005240:Feasibility Studies; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D017410:Practice Guidelines as Topic; D012042:Registries; D016019:Survival Analysis