Urban and rural implementation of pre-hospital diagnosis and direct referral for primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction.
OBJECTIVE
Primary percutaneous coronary intervention (PCI) is the preferred treatment for ST-elevation myocardial infarction (STEMI). The distance to primary PCI centres and the inherent time delay in delivering primary PCI, however, limit widespread use of this treatment. This study aimed to evaluate the impact of pre-hospital diagnosis on time from emergency medical services contact to balloon inflation (system delay) in an unselected cohort of patients with STEMI recruited from a large geographical area comprising both urban and rural districts.


RESULTS
From February 2004 until January 2007, data on pre-hospital timing and transport distance were prospectively recorded. Patients were divided into groups depending on achievement of pre-hospital diagnosis and/or direct referral to a primary PCI centre. Seven hundred and fifty-nine consecutive STEMI patients were included. In patients with a pre-hospital diagnosis and direct referral, the system delay was 92 vs. 153 min in patients without pre-hospital diagnosis (P < 0.001). Patients from rural areas were transported a median of 30 km longer than patients from urban areas; however, this prolonged the system delay by only 9 min.


CONCLUSIONS
Pre-hospital electrocardiographic (ECG) diagnosis and direct referral for primary PCI enables STEMI patients living far from a PCI centre to achieve a system delay comparable with patients living in close vicinity of a PCI centre.
Department of Cardiology B, Aarhus University Hospital, Skejby, Aarhus N, Denmark. jacobthorsted@gmail.com
Jacob Thorsted
JT
Sørensen
Christian Juhl
CJ
Terkelsen
Bjarne Linde
BL
Nørgaard
Sven
S
Trautner
Troels Martin
TM
Hansen
Hans Erik
HE
Bøtker
Jens Flensted
JF
Lassen
Henning Rud
HR
Andersen
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality / Q000706:statistics & numerical data*; D003718:Denmark / Q000453:epidemiology; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality; D011446:Prospective Studies; D012017:Referral and Consultation / Q000592:standards* / Q000706:statistics & numerical data; D012423:Rural Health; D017216:Telemedicine; D013997:Time Factors; D014504:Urban Health