What question did this study set out to answer?

To evaluate the impact of prehospital telemedicine diagnosis and direct catheterization laboratory referral on treatment delay and mortality in patients with ST-elevation myocardial infarction.

June 1, 2008Journal of Cardiovascular Medicine

Impact of prehospital diagnosis in the management of ST elevation myocardial infarction in the era of primary percutaneous coronary intervention: reduction of treatment delay and mortality

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Why the study?

Does prehospital diagnosis and direct transfer reduce in-hospital mortality and treatment delay in STEMI patients undergoing primary PCI?

Population

399 STEMI patients referred to an interventional centre for primary PCI

Comparison

Prehospital diagnosis with telemedicine… vs Diagnosis following admission to First Aid

Design

Cohort

Follow-up

in-hospital

Authors

RZRoberto ZaniniAssociazione Nazionale Medici Cardiologi Ospedalieri MAMarco AroldiAzienda Ospedaliera Carlo Poma SBSilvia BonattiUniversity of Modena and Reggio Emilia

Discussion

Member takes

Implication

May support prehospital STEMI diagnosis; leaves open causal confirmation in randomized trials.

Key Points

To evaluate the impact of prehospital telemedicine diagnosis and direct catheterization laboratory referral on treatment delay and mortality in patients with ST-elevation myocardial infarction.
Analyzed 399 STEMI patients referred for primary percutaneous coronary intervention (PCI) at a 24-hour interventional center.
Compared Group A (n=263, diagnosed after admission to First Aid) with Group B (n=136, diagnosed prehospital via telemedicine and transferred directly by advanced life support ambulance).
Treatment delay was significantly lower in Group B than in Group A (148 ± 81 min vs. 262 ± 112 min, P < 0.001).
Total mortality was significantly reduced in Group B compared with Group A (3.0% vs. 8.7%, P < 0.05).
Independent multivariate predictors of in-hospital mortality included age and Killip class (P < 0.01), along with referral pathway, pre-PCI TIMI flow, and onset-to-balloon time (P < 0.05).

Structured PICO

Does prehospital diagnosis and direct transfer reduce in-hospital mortality and treatment delay in STEMI patients undergoing primary PCI?

Population

399 STEMI patients referred to an interventional centre for primary PCI

Intervention

Prehospital diagnosis with telemedicine equipment and direct transfer to the interventional centre by advanced life support (ALS) ambulance

Comparator

Diagnosis following admission to First Aid

Outcome

In-hospital mortality and percutaneous coronary intervention (PCI) mortalityhard clinical

Prehospital ECG diagnosis with direct referral to the catheterization laboratory significantly reduces treatment delays and in-hospital mortality for STEMI patients.

Cite This Study

Zanini et al. (2008) studied this question.

synapsesocial.com/papers/6a7eb98d336367db4c339027 https://doi.org/10.2459/jcm.0b013e3282f2c9bd

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Impact of prehospital diagnosis in the management of ST elevation myocardial infarction in the era of primary percutaneous coronary intervention: reduction of treatment delay and mortality

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Impact of prehospital diagnosis in the management of ST elevation myocardial infarction in the era of primary percutaneous coronary intervention: reduction of treatment delay and mortality

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Also Consider