title: Prehospital activation of cardiac catheterization teams in ST-segment elevation myocardial infarction.
abstract: OBJECTIVE
  Current clinical guidelines for ST-segment elevation myocardial infarction (STEMI) suggest prehospital activation of the cardiac catheterization team. In previous protocols in our center activation occurred once patients arrived at the hospital. In January 2011, we initiated a new primary angioplasty activation protocol from prehospital locations. Our objective was to quantify the influence of this change on reperfusion times.
  
  
  METHODS
  A total of 173 consecutive STEMI patients (n=73/100 before/after initiation of the new protocol), diagnosed in a prehospital setting within 12 hours of symptom onset, were analyzed. The time between the patient's arrival at the hospital and beginning of the angioplasty procedure was termed the cath lab activation delay.
  
  
  RESULTS
  The new protocol resulted in a 37-min reduction in system delay (166 [132-235] min before vs. 129 [105-166] min after, p<0.001), mostly driven by a 64% reduction in cath lab activation delay (55 [0-79] min before vs. 20 [0-54] min after, p=0.001). This reduction was mainly observed outside working hours. The percentage of patients treated with a system delay ≤ 120 min increased from 14.5% before the new protocol to 41.8% afterwards (p=0.001).
  
  
  CONCLUSIONS
  Prehospital activation of the cardiac catheterization team resulted in earlier reperfusion of STEMI patients.
authors.affiliation: Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Franco
authors.affiliation: Servicio de Urgencia Médica de Madrid (SUMMA 112), Madrid, Spain.
authors.forename: Alonso
authors.initials: A
authors.lastname: Mateos
authors.affiliation: Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Acebal
authors.affiliation: Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Fernández-Ortiz
authors.affiliation: Servicio de Urgencia Médica de Madrid (SUMMA 112), Madrid, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Sánchez-Brunete
authors.affiliation: Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: García-Rubira
authors.affiliation: Servicio de Urgencia Médica de Madrid (SUMMA 112), Madrid, Spain.
authors.forename: María José
authors.initials: MJ
authors.lastname: Fernández-Campos
authors.affiliation: Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
authors.affiliation: Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain. Electronic address: bibanez@cnic.es.
authors.forename: Borja
authors.initials: B
authors.lastname: Ibáñez
mesh_terms: D039602:After-Hours Care; D000368:Aged; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D002985:Clinical Protocols; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology / Q000628:therapy*; D015425:Myocardial Reperfusion; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D013997:Time Factors
keywords: Angioplastia coronária; Atraso no tratamento; Coronary angioplasty; Enfarte do miocárdio; Ischemia time; Myocardial infarction; Tempo de isquemia; Treatment delay