Z Kardiol 94: Suppl 2 (2005)

Prehospital diagnosis of ST-segment elevation myocardial infarction and direct transport to the catheterization laboratory: How many patients are not eligible for coronary angioplasty?  
J. Carlsson1, J. Qvist1, P. Reinius1, T. Muhr1
1Medicinsk klinik, Länssjukhuset, Kalmar, SE;

Guidelines favour primary angioplasty (pPCI) for patients with ST-segment elevation infarction (STEMI). One way to reduce delay to treatment is the prehospital diagnosis of STEMI and the transport of the patient directly to the catheterization laboratory (cathlab). How many of these patients have other diagnoses than STEMI or have other conditions that represent a relative or absolute contraindication against pPCI?

Between October 2003 and April 2005 197 patients with STEMI were examined acutely at our hospital. 54 of these (27%) had been diagnosed at the emergency department of our hospital, resp. two other hospitals that have no invasive cardiology facilities (group A). All patients of group A had been seen by a physician specialized in internal medicine and then been referred  to pPCI. 143 patients (73%) had been evaluated by ambulance nurses and diagnosed pre-hospitally (group B). Pre-hospital diagnoses were established with the use of telemedicine: A 12-lead ECG was obtained on scene for transmission to the interventional centre. A physician on call evaluated the ECG. The patient was then transported directly to the cathlab. The clinical characteristics of the patients in group A versus group 2 did not differ significantly. 190 of 197 patients underwent pPCI (96%). The remaining 7 patients (3 of group A, 4 of group B) had other diagnoses than STEMI or PCI was judged technically not feasible (table). In additionally two patients of group B the indication for pPCI was questioned later because of patients severe dementia, resp. a malignant disease that severely limited life expectancy.  

Condition

Group A (n=54)

Group B (n=143)

Left ventricular aneurysm with persistent ST-elevation

1 (2%)

1 (0,7%)

Aortic dissection

1 (2%)

0

pPCI technically not feasible

-acute CABG

-intracoronary thrombolysis

 

0

1 (2%)


 

2 (1,4%)

1 (0,7%)

The time delay between ambulance call/hospital contact and first balloon inflation was significant different between the two groups: 134 min (group A) versus 69 min (group B).

A pre-hospital diagnosis of STEMI with the help of telemedicine is both feasible and safe and leads to a significant reduction of the time delay between ambulance arrival and first balloon inflation. The frequency of patients that are not eligible for pPCI is not higher in patients that had not been seen by a medical doctor before referral to the cathlab.

This should lead to a further reduction in mortality in these patients. However, larger studies are needed to demonstrate mortality differences.


http://www.abstractserver.de/dgk2005/ht/abstracts/P345.htm