title: Impact of mobile intensive care unit use on total ischemic time and clinical outcomes in ST-elevation myocardial infarction patients - real-world data from the Acute Coronary Syndrome Israeli Survey.
abstract: BACKGROUND
  Ischemic time has prognostic importance in ST-elevation myocardial infarction patients. Mobile intensive care unit use can reduce components of total ischemic time by appropriate triage of ST-elevation myocardial infarction patients.
  
  
  METHODS
  Data from the Acute Coronary Survey in Israel registry 2000-2010 were analyzed to evaluate factors associated with mobile intensive care unit use and its impact on total ischemic time and patient outcomes.
  
  
  RESULTS
  The study comprised 5474 ST-elevation myocardial infarction patients enrolled in the Acute Coronary Survey in Israel registry, of whom 46% ( n=2538) arrived via mobile intensive care units. There was a significant increase in rates of mobile intensive care unit utilization from 36% in 2000 to over 50% in 2010 ( p<0.001). Independent predictors of mobile intensive care unit use were Killip>1 (odds ratio=1.32, p<0.001), the presence of cardiac arrest (odds ratio=1.44, p=0.02), and a systolic blood pressure <100 mm Hg (odds ratio=2.01, p<0.001) at presentation. Patients arriving via mobile intensive care units benefitted from increased rates of primary reperfusion therapy (odds ratio=1.58, p<0.001). Among ST-elevation myocardial infarction patients undergoing primary reperfusion, those arriving by mobile intensive care unit benefitted from shorter median total ischemic time compared with non-mobile intensive care unit patients (175 (interquartile range 120-262) vs 195 (interquartile range 130-333) min, respectively ( p<0.001)). Upon a multivariate analysis, mobile intensive care unit use was the most important predictor in achieving door-to-balloon time <90 min (odds ratio=2.56, p<0.001) and door-to-needle time <30 min (odds ratio=2.96, p<0.001). One-year mortality rates were 10.7% in both groups (log-rank p-value=0.98), however inverse propensity weight model, adjusted for significant differences between both groups, revealed a significant reduction in one-year mortality in favor of the mobile intensive care unit group (odds ratio=0.79, 95% confidence interval (0.66-0.94), p=0.01).
  
  
  CONCLUSIONS
  Among patients with ST-elevation myocardial infarction, the utilization of mobile intensive care units is associated with increased rates of primary reperfusion, a reduction in the time interval to reperfusion, and a reduction in one-year adjusted mortality.
authors.affiliation: 1 Heart Institute, Chaim Sheba Medical Center, Israel.|2 Sackler School of Medicine, Tel Aviv University, Israel.
authors.forename: Edward
authors.initials: E
authors.lastname: Koifman
authors.affiliation: 1 Heart Institute, Chaim Sheba Medical Center, Israel.|2 Sackler School of Medicine, Tel Aviv University, Israel.
authors.forename: Roy
authors.initials: R
authors.lastname: Beigel
authors.affiliation: 2 Sackler School of Medicine, Tel Aviv University, Israel.|3 Cardiology Department, Rabin Medical Center, Israel.
authors.forename: Zaza
authors.initials: Z
authors.lastname: Iakobishvili
authors.affiliation: 4 Israeli Association for Cardiovascular Trials, Israel.
authors.forename: Nir
authors.initials: N
authors.lastname: Shlomo
authors.affiliation: 1 Heart Institute, Chaim Sheba Medical Center, Israel.|2 Sackler School of Medicine, Tel Aviv University, Israel.
authors.forename: Yitschak
authors.initials: Y
authors.lastname: Biton
authors.affiliation: 1 Heart Institute, Chaim Sheba Medical Center, Israel.|2 Sackler School of Medicine, Tel Aviv University, Israel.
authors.forename: Avi
authors.initials: A
authors.lastname: Sabbag
authors.affiliation: 1 Heart Institute, Chaim Sheba Medical Center, Israel.|2 Sackler School of Medicine, Tel Aviv University, Israel.
authors.forename: Elad
authors.initials: E
authors.lastname: Asher
authors.affiliation: 5 Department of Cardiovascular Medicine, Galilee Medical Center, Nahariya, Israel.|6 Faculty of Medicine of the Galilee, Bar-Ilan University, Sefad, Israel.
authors.forename: Shaul
authors.initials: S
authors.lastname: Atar
authors.affiliation: 7 Department of Cardiology, Shaare Zedek Medical Center, Israel.
authors.forename: Shmuel
authors.initials: S
authors.lastname: Gottlieb
authors.affiliation: 8 Heart institute Hadassah, Hebrew University Medical Center and School, Israel.
authors.forename: Ronny
authors.initials: R
authors.lastname: Alcalai
authors.affiliation: 9 Department of Cardiology, Soroka University Medical Center, Israel.|10 Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel.
authors.forename: Doron
authors.initials: D
authors.lastname: Zahger
authors.affiliation: 1 Heart Institute, Chaim Sheba Medical Center, Israel.|2 Sackler School of Medicine, Tel Aviv University, Israel.
authors.forename: Amit
authors.initials: A
authors.lastname: Segev
authors.affiliation: 1 Heart Institute, Chaim Sheba Medical Center, Israel.|2 Sackler School of Medicine, Tel Aviv University, Israel.|4 Israeli Association for Cardiovascular Trials, Israel.
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.affiliation: 11 Magen David Adom, Israel.
authors.forename: Rafael
authors.initials: R
authors.lastname: Strugo
authors.affiliation: 1 Heart Institute, Chaim Sheba Medical Center, Israel.|2 Sackler School of Medicine, Tel Aviv University, Israel.|4 Israeli Association for Cardiovascular Trials, Israel.
authors.forename: Shlomi
authors.initials: S
authors.lastname: Matetzky
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D000552:Ambulances / Q000706:statistics & numerical data*; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012042:Registries; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D011795:Surveys and Questionnaires; D015996:Survival Rate / Q000639:trends; D061665:Time-to-Treatment / Q000639:trends*
keywords: Mobile intensive care; ST elevation myocardial infarction; primary reperfusion; prognosis