title: Prehospital triage for angiography-guided therapy for acute myocardial infarction.
abstract: BACKGROUND
  Time between symptom onset and effective reperfusion is of paramount importance in patients with acute myocardial infarction (MI) treated with reperfusion therapy. In the PHIAT (Pre-Hospital Infarction Angioplasty Triage) project, safety and feasibility of in-ambulance electrocardiography facilities for prehospital triage for direct transfer to an interventional centre to undergo immediate coronary angiography and angiography-guided therapy were evaluated.
  
  
  RESULTS
  The ambulances were equipped with a defibrillator and electrocardiography unit with computerised electrocardiographic analysis. Patients with acute MI symptoms and fulfilling certain criteria compatible with a large MI were included and pretreated with heparin and aspirin during transportation. During the study period, 284 patients were included. Eleven percent did not have an acute MI. PCI, performed in 94% (n=239) of the patients, was successful in 94%. Prehospital triage reduced time to treatment. In 32% of the patients triage resulted in direct transportation to the interventional centre instead of to the nearest community hospital. All-cause mortality was 9% after a mean follow-up of nine months. No serious bleeding complications were seen.
  
  
  CONCLUSIONS
  Prehospital triage in the ambulance is safe and feasible. A striking percentage (11%) of the identified patients does not have an acute MI and this is more than has been reported from prehospital thrombolysis trials.
authors.forename: N M S K J
authors.initials: NM
authors.lastname: Ernst
authors.forename: M J
authors.initials: MJ
authors.lastname: de Boer
authors.forename: A W J
authors.initials: AW
authors.lastname: van 't Hof
authors.forename: F
authors.initials: F
authors.lastname: Hollak
authors.forename: H
authors.initials: H
authors.lastname: van de Wetering
authors.forename: J H E
authors.initials: JH
authors.lastname: Dambrink
authors.forename: J C A
authors.initials: JC
authors.lastname: Hoorntje
authors.forename: H
authors.initials: H
authors.lastname: Suryapranata
authors.forename: F
authors.initials: F
authors.lastname: Zijlstra
keywords: myocardial infarction; prehospital triage; primary angioplasty