title: Pre-hospital alarm activation for STEMI patients undergoing primary percutaneous coronary intervention in the era of transradial procedures.
abstract: BACKGROUND
  Transradial access (TRA) improves outcome compared with trans-femoral access for the management of patients with acute coronary syndromes. In this setting, it is unknown whether the activation of a pre-hospital alarm system (PHAS) confers additional benefit for the prognosis of patients with ST-segment elevation myocardial infarction (STEMI).
  
  
  METHODS
  We retrospectively analyzed a cohort of patients with a first STEMI who underwent a primary percutaneous coronary intervention (PPCI) at a single center within a prospective cohort of acute coronary syndrome patients (SPUM-ACS). TRA was used in 85% of patients. We assessed how PHAS (n=165) vs. no-PHAS (n=166) activation was associated with the composite outcome of all-cause mortality and recurrence of myocardial infarction (MI) at 1-year follow-up. As secondary outcomes, the individual clinical endpoints were separately assessed for association.
  
  
  RESULTS
  Compared with no-PHAS patients, patients in the PHAS group were predominantly women, and presented more frequently with dyslipidemia and cardiac arrest. A significant reduction in the composite outcome of all-cause mortality and recurrent MI at 1-year was observed in the PHAS group, compared with no-PHAS (3.6% vs. 8.5%, p=0.027). When adjusted for age, sex and resuscitation status, PHAS activation remained associated with decreased all-cause mortality and recurrent MI (HR: 0.36 [95% CI: 0.13-0.95]; p=0.040).
  
  
  CONCLUSIONS
  This study suggests that the benefit of PHAS activation in STEMI patients undergoing PPCI persists also in the era of TRA.
authors.affiliation: Division of Cardiology, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland. Electronic address: Fabio.rigamonti@hcuge.ch.
authors.forename: Fabio
authors.initials: F
authors.lastname: Rigamonti
authors.affiliation: Division of Cardiology, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland. Electronic address: baris.gencer@hcuge.ch.
authors.forename: Baris
authors.initials: B
authors.lastname: Gencer
authors.affiliation: Division of Cardiology, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland. Electronic address: florian.rey@hcuge.ch.
authors.forename: Florian
authors.initials: F
authors.lastname: Rey
authors.affiliation: Division of Cardiology, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland. Electronic address: jawad.chaara@hcuge.ch.
authors.forename: Jawad
authors.initials: J
authors.lastname: Chaara
authors.affiliation: Division of Cardiology, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland. Electronic address: elena.tessitore@hcuge.ch.
authors.forename: Elena
authors.initials: E
authors.lastname: Tessitore
authors.affiliation: Division of Cardiology, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland. Electronic address: sholanbunwaree@yahoo.co.uk.
authors.forename: Sholan
authors.initials: S
authors.lastname: Bunwaree
authors.affiliation: Division of Cardiology, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland. Electronic address: pascal.meier@hcuge.ch.
authors.forename: Pascal
authors.initials: P
authors.lastname: Meier
authors.affiliation: Division of Cardiology, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland. Electronic address: stephane.noble@hcuge.ch.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Noble
authors.affiliation: Division of General Internal Medicine, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland; Division of Emergency Medicine, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland. Electronic address: olivier.grosgurin@hcuge.ch.
authors.forename: Olivier
authors.initials: O
authors.lastname: Grosgurin
authors.affiliation: Division of Emergency Medicine, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland. Electronic address: robert.larribau@hcuge.ch.
authors.forename: Robert
authors.initials: R
authors.lastname: Larribau
authors.affiliation: Division of Cardiology, Bern University Hospital, 3010 Bern, Switzerland. Electronic address: stephan.windecker@insel.ch.
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.affiliation: First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy. Electronic address: Federico.carbone@edu.unige.it.
authors.forename: Federico
authors.initials: F
authors.lastname: Carbone
authors.affiliation: First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; IRCCS AOU San Martino - IST, 10 largo Benzi, 16132 Genoa, Italy. Electronic address: Fabrizio.montecucco@unige.it.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Montecucco
authors.affiliation: Department of General Internal Medicine, Inselspital, Bern University Hospital, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM) University of Bern, 3010 Bern, Switzerland. Electronic address: nicolas.rodondi@insel.ch.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Rodondi
authors.affiliation: Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland; Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland. Electronic address: christian.matter@uzh.ch.
authors.forename: Christian M
authors.initials: CM
authors.lastname: Matter
authors.affiliation: Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland; Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland. Electronic address: cardiotfl@gmx.ch.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Luscher
authors.affiliation: Division of Cardiology, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland. Electronic address: francois.mach@hcuge.ch.
authors.forename: François
authors.initials: F
authors.lastname: Mach
authors.affiliation: Division of Cardiology, Department of Medical Specialties, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland. Electronic address: marco.roffi@hcuge.ch.
authors.forename: Marco
authors.initials: M
authors.lastname: Roffi
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications*; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D017534:Radial Artery / Q000601:surgery; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D013557:Switzerland; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007166:Immunosuppressive Agents
keywords: Pre-hospital alarm system; Primary PCI; STEMI; Transradial access