Key result
Primary transport of STEMI patients directly to a PCI center was associated with significantly lower 1-year mortality compared to secondary transport (7.3% vs 20.5%; p<0.005).
Why the study?
Does primary transport directly to a PCI center reduce door-to-balloon time and mortality in STEMI patients compared to secondary transport?
Cohort (n=677)
Does primary transport directly to a PCI center reduce door-to-balloon time and mortality in STEMI patients compared to secondary transport?
Absolute Event Rate: 7.3% vs 20.5%
p-value: p=<0.005
Direct primary transport of STEMI patients to a PCI-capable center significantly reduces door-to-balloon time and improves short- and long-term survival.
May inform STEMI transport protocols; leaves open need for RCTs before practice change.
In ST-elevation myocardial infarction (STEMI), the pre-hospital phase is the most critical and appropriate treatment in a timely manner which is instrumental for mortality reduction. STEMI systems of care based on networks of medical institutions connected by an efficient emergency medical service (EMS) are pivotal. The first steps are devoted to minimizing patient’s delay in seeking care, quickly dispatching emergency personnel with equipped ambulance to be able to make the diagnosis on scene, deliver initial drug and therapy and also transport the patient to the most appropriate (not necessarily the closest) cardiac facility or hospital. Primary percutaneous coronary intervention (PCI) is a treatment of choice, but thrombolysis followed by coronary angiography and possibly PCI are valid alternatives. Strong cooperations between cardiologists and emergency medicine doctors are mandatory for optimal pre-hospital STEMI care. In this study, we prospectively recorded door to balloon time (DBT) for consecutive patients with STEMI, treated by PCI. For six hundred and seventy seven patients with mean 64 ± 16 years, 475 (70%) males and 202 (30%) females were enrolled for the final analysis. From this number, 354 (52.3%) patients had primary transport by emergency services (PT) and 323 (47.7%) secondary transport (ST). Median of DBT was 34 ±15.9 mins for PT patients (n=354) and 100 ±28.8 mins for patients with ST (n=323) (p<0.00005). One month mortality rate was 4% vs 9.5% (p=0.002) in the PT vs ST group, respectively. One-year mortality rate in the PT and ST groups were 7.3% vs 20.5% (p<0.005), respectively. We found out that patients who were sent directly to a PCI center had significantly shorter time for reperfusion and lower mortality.
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Al Mawiri A. (2016) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=677). Primary transport by emergency services vs. Secondary transport was evaluated on 1-year mortality (p=<0.005). Primary transport of STEMI patients directly to a PCI center was associated with significantly lower 1-year mortality compared to secondary transport (7.3% vs 20.5%; p<0.005).
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