title: The impact of direct admission to a catheterisation lab/CCU in patients with ST-elevation myocardial infarction on the delay to reperfusion and early risk of death: results of a systematic review including meta-analysis.
abstract: BACKGROUND
  For each hour of delay from fist medical contact until reperfusion in ST-elevation myocardial infarction (STEMI) there is a 10% increase in risk of death and heart failure. The aim of this review is to describe the impact of the direct admission of patients with STEMI to a Catheterisation laboratory (cath lab) as compared with transport to the emergency department (ED) with regard to delays and outcome.
  
  
  METHODS
  Databases were searched for from April-June 2012 and updated January 2014: 1) Pubmed; 2) Embase; 3) Cochrane Library; 4) ProQuest Nursing and 5) Allied Health Sources. The search was restricted to studies in English, Swedish, Danish and Norwegian languages. The intervention was a protocol-based clinical pre-hospital pathway and main outcome measurements were the delay to balloon inflation and hospital mortality.
  
  
  RESULTS
  Median delay from door to balloon was significantly shorter in the intervention group in all 5 studies reported. Difference in median delay varied between 16 minutes and 47 minutes. In all 7 included studies the time from symptom onset or first medical contact to balloon time was significantly shorter in the intervention group. The difference in median delay varied between 15 minutes and 1 hour and 35 minutes. Only two studies described hospital mortality. When combined the risk of death was reduced by 37%.
  
  
  CONCLUSIONS
  An overview of available studies of the impact of a protocol-based pre-hospital clinical pathway with direct admission to a cath lab as compared with the standard transport to the ED in ST-elevation AMI suggests the following. The delay to the start of revascularisation will be reduced. The clinical benefit is not clearly evidence based. However, the documented association between system delay and outcome defends the use of the pathway.
authors.affiliation: School of Health Sciences, The Centre for Pre-hospital Research, University of Borås, SE-501 90, Borås, Sweden. Magnus.Hagiwara@hb.se.
authors.forename: Magnus Andersson
authors.initials: MA
authors.lastname: Hagiwara
authors.affiliation: School of Health Sciences, The Centre for Pre-hospital Research, University of Borås, SE-501 90, Borås, Sweden. Anders.Bremer@hb.se.
authors.forename: Anders
authors.initials: A
authors.lastname: Bremer
authors.affiliation: School of Health Sciences, The Centre for Pre-hospital Research, University of Borås, SE-501 90, Borås, Sweden. Andreas.Claesson@hb.se.
authors.forename: Andreas
authors.initials: A
authors.lastname: Claesson
authors.affiliation: School of Health Sciences, The Centre for Pre-hospital Research, University of Borås, SE-501 90, Borås, Sweden. Christer.Axelsson@hb.se.
authors.forename: Christer
authors.initials: C
authors.lastname: Axelsson
authors.affiliation: School of Health Sciences, The Centre for Pre-hospital Research, University of Borås, SE-501 90, Borås, Sweden. Gabriella.Norberg@hb.se.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Norberg
authors.affiliation: School of Health Sciences, The Centre for Pre-hospital Research, University of Borås, SE-501 90, Borås, Sweden. johan.herlitz@gu.se.|Inst of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, SE-413 45, Göteborg, Sweden. johan.herlitz@gu.se.
authors.forename: Johan
authors.initials: J
authors.lastname: Herlitz
mesh_terms: D004562:Electrocardiography; D004632:Emergency Medical Services / Q000458:organization & administration*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods*; D010343:Patient Admission / Q000592:standards*; D012307:Risk Factors; D013997:Time Factors