title: [Transport and treatment of patients with STEMI in rural Iceland--Only a few patients receive PPCI within 120 minutes].
abstract: BACKGROUND
  ST-segment Elevation Myocardial Infarction (STEMI) is a life-threatening disease and good outcome depends on early restoration of coronary blood flow. Primary percutaneous coronary intervention (PPCI) is the treatment of choice if performed within 120 minutes of first medical contact (FMC) but in case of anticipated long transport or delays, pre-hospital fibrinolysis is indicated. The aim was to study transport times and adherence to clinical guidelines in patients with STEMI transported from outside of the Reykjavik area to Landspitali University Hospital in Iceland.
  
  
  METHODS
  Retrospective chart review was conducted of all patients diagnosed with STEMI outside of the Reykjavik area and transported to Landspitali University Hospital in Reykjavik in 2011-2012. Descriptive statistical analysis and hypothesis testing was applied.
  
  
  RESULTS
  Eighty-six patients had signs of STEMI on electrocardiogram (ECG) at FMC. In southern Iceland nine patients (21%) underwent PPCI within 120 minutes (median 157 minutes) and no patient received fibrinolysis. In northern Iceland and The Vestman Islands, where long transport times are expected, 96% of patients eligible for fibrinolysis (n=31) received appropriate therapy in a median time of 57 minutes. Significantly fewer patients received appropriate anticoagulation treatment with clopidogrel and enoxaparin in southern Iceland compared to the northern part. Mortality rate was 7% and median length of stay in hospital was 6 days.
  
  
  CONCLUSIONS
  Time from FMC to PPCI is longer than 120 minutes in the majority of cases. Pre-hospital fibrinolysis should be considered as first line treatment in all parts of Iceland outside of the Reykjavik area. Directly electronically transmitted ECGs and contact with cardiologist could hasten diagnosis and decrease risk of unnecessary interhospital transfer. A STEMI database should be established in Iceland to facilitate quality control.
authors.forename: Thórir S
authors.initials: TS
authors.lastname: Sigmundsson
authors.forename: Daníel
authors.initials: D
authors.lastname: Arnarson
authors.forename: Arnar
authors.initials: A
authors.lastname: Rafnsson
authors.forename: Viðar
authors.initials: V
authors.lastname: Magnússon
authors.forename: Gunnar Thór
authors.initials: GT
authors.lastname: Gunnarsson
authors.forename: Gestur
authors.initials: G
authors.lastname: Thorgeirsson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D003695:Delivery of Health Care / Q000458:organization & administration*; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000458:organization & administration; D005260:Female; D019983:Guideline Adherence; D006785:Hospitals, University; D006801:Humans; D007055:Iceland; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D019035:Rural Health Services / Q000458:organization & administration*; D015912:Thrombolytic Therapy; D013997:Time Factors; D061665:Time-to-Treatment / Q000458:organization & administration*; D014187:Transportation of Patients / Q000458:organization & administration*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors