Impact of the Type of First Medical Contact within a Guideline-Conform ST-Elevation Myocardial Infarction Network: A Prospective Observational Registry Study.
OBJECTIVE
The impact of type of first medical contact (FMC) in the setting of a guideline conform metropolitan ST-elevation myocardial infarction (STEMI) network providing obligatory primary percutaneous coronary intervention (PCI) is unclear.


RESULTS
3,312 patients were prospectively included between 2006 and 2012 into a registry accompanying the "Cologne Infarction Model" STEMI network, with 68.4% primarily presenting to emergency medical service (EMS), 17.6% to non-PCI-capable hospitals, and 14.0% to PCI-capable hospitals. Median contact-to-balloon time differed significantly by FMC with 89 minutes (IQR 72-115) for EMS, 107 minutes (IQR 85-148) for non-PCI- and 65 minutes (IQR 48-91) for PCI-capable hospitals (p < 0.001). TIMI-flow grade III and in-hospital mortality were 75.7% and 10.4% in EMS, 70.3% and 8.6% in non-PCI capable hospital and 84.4% and 5.6% in PCI-capable hospital presenters, respectively (p both < 0.01). The association of FMC with in-hospital mortality was not significant after adjustment for baseline characteristics, but risk of TIMI-flow grade < III remained significantly increased in patients presenting to non-PCI capable hospitals.


CONCLUSIONS
Despite differences in treatment delay by type of FMC in-hospital mortality did not differ significantly. The increased risk of TIMI-flow grade < III in patients presenting to non PCI-capable hospitals needs further study.
Department III of Internal Medicine, University of Cologne, Cologne, Germany.
Roman
R
Pfister
Department III of Internal Medicine, University of Cologne, Cologne, Germany.
Samuel
S
Lee
Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany.
Kathrin
K
Kuhr
St. Antonius Hospital, Cologne, Germany.
Frank
F
Baer
St. Vinzenz Hospital, Cologne, Germany.
Wolfgang
W
Fehske
Department III of Internal Medicine, University of Cologne, Cologne, Germany.
Hans-Wilhelm
HW
Hoepp
Department III of Internal Medicine, University of Cologne, Cologne, Germany.
Stephan
S
Baldus
Department III of Internal Medicine, University of Cologne, Cologne, Germany.
Guido
G
Michels
D000368:Aged; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000502:physiology; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D012042:Registries; D000072657:ST Elevation Myocardial Infarction; D013997:Time Factors