title: Pre-hospital ECG in patients undergoing primary percutaneous interventions within an integrated system of care: reperfusion times and long-term survival benefits.
abstract: OBJECTIVE
  Treatment delay is a powerful predictor of survival in STEMI patients undergoing primary PCI. We investigated the effectiveness of pre-hospital triage with direct referral to PCI, alongside more conventional referral strategies.
  
  
  RESULTS
  From January 2003 to December 2007, 1,619 STEMI patients were referred for primary PCI at our cathlab through two main triage groups: i.e., 1) following pre-hospital triage (n=524), 2) via more conventional triages (n=1,095) represented by the S. Orsola-Malpighi hospital emergency department triage (hub hospital) and local hospital triage. Pre-hospital diagnosis was associated with a 76 minute reduction in pain-to-balloon time (143 [107-216] vs. 219 [149-343], p=0.001) allowing mechanical revascularisation within 90 minutes from the first medical contact in the vast majority of the patients (>80%). Clinically, pre-hospital triage showed no significant reductions in terms of adjusted long-term mortality (HR 0.81, 95% CI 0.61-1.08; p=0.16) in the overall population. However, significant adjusted survival benefits were observed in high-risk groups (i.e., cardiogenic shock, TIMI risk score >30, diabetes mellitus).
  
  
  CONCLUSIONS
  This study shows that pre-hospital diagnosis allows for significant reductions in primary PCI treatment delays and suggests the hypothesis that this referral strategy might provide long-term survival benefits especially in high-risk patients.
authors.affiliation: Department of Cardiology, S. Orsola-Malpighi Hospital, University of Bologna, Italy. paortol@tin.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Ortolani
authors.forename: Antonio
authors.initials: A
authors.lastname: Marzocchi
authors.forename: Cinzia
authors.initials: C
authors.lastname: Marrozzini
authors.forename: Tullio
authors.initials: T
authors.lastname: Palmerini
authors.forename: Francesco
authors.initials: F
authors.lastname: Saia
authors.forename: Nevio
authors.initials: N
authors.lastname: Taglieri
authors.forename: Laura
authors.initials: L
authors.lastname: Alessi
authors.forename: Paola
authors.initials: P
authors.lastname: Nardini
authors.forename: Maria-Letizia
authors.initials: ML
authors.lastname: Bacchi Reggiani
authors.forename: Paolo
authors.initials: P
authors.lastname: Guastaroba
authors.forename: Rossana
authors.initials: R
authors.lastname: De Palma
authors.forename: Roberto
authors.initials: R
authors.lastname: Grilli
authors.forename: Cosimo
authors.initials: C
authors.lastname: Picoco
authors.forename: Giovani
authors.initials: G
authors.lastname: Gordini
authors.forename: Angelo
authors.initials: A
authors.lastname: Branzi
mesh_terms: D000368:Aged; D000552:Ambulances; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D017023:Coronary Angiography; D019033:Delivery of Health Care, Integrated; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D018579:Patient Selection; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012017:Referral and Consultation; D012040:Regional Health Planning; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013686:Telemetry; D013997:Time Factors; D016896:Treatment Outcome; D014218:Triage