Reperfusion delay in patients treated with primary percutaneous coronary intervention: insight from a real world Danish ST-segment elevation myocardial infarction population in the era of telemedicine
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Reperfusion delay in patients treated with primary percutaneous coronary intervention : insight from a real world Danish ST-segment elevation myocardial infarction population in the era of telemedicine. / Schoos, Mikkel M; Sejersten, Maria; Hvelplund, Anders; Madsen, Mette; Lønborg, Jacob; Steinmetz, Jacob; Treschow, Philip M; Pedersen, Frants; Jørgensen, Erik; Grande, Peer; Kelbæk, Henning; Clemmensen, Peter.
In: European Heart Journal: Acute Cardiovascular Care, Vol. 1, No. 3, 09.2012, p. 200-9.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Reperfusion delay in patients treated with primary percutaneous coronary intervention
T2 - insight from a real world Danish ST-segment elevation myocardial infarction population in the era of telemedicine
AU - Schoos, Mikkel M
AU - Sejersten, Maria
AU - Hvelplund, Anders
AU - Madsen, Mette
AU - Lønborg, Jacob
AU - Steinmetz, Jacob
AU - Treschow, Philip M
AU - Pedersen, Frants
AU - Jørgensen, Erik
AU - Grande, Peer
AU - Kelbæk, Henning
AU - Clemmensen, Peter
PY - 2012/9
Y1 - 2012/9
N2 - BACKGROUND: Reperfusion delay in ST-segment elevation myocardial infarction (STEMI) predicts adverse outcome. We evaluated time from alarm call (system delay) and time from first medical contact (PCI-related delay), where fibrinolysis could be initiated, to balloon inflation in a pre-hospital organization with tele-transmitted electrocardiograms, field triage and direct transfer to a 24/7 primary percutaneous coronary intervention (PPCI) center.METHODS AND RESULTS: This was a single center cohort study with long-term follow-up in 472 patients. The PPCI center registry was linked by person identification number to emergency medical services (EMS) and National Board of Health databases in the period of 2005-2008. Patients were stratified according to transfer distances to PPCI into zone 1 (0-25 km), zone 2 (65-100 km) and zone 3 (101-185 km) and according to referral by pre-hospital triage. System delay was 86 minutes (interquartile range (IQR) 72-113) in zone 1, 133 (116-180) in zone 2 and 173 (145-215) in zone 3 (p<0.001). PCI-related delay in directly referred patients was 109 (92-121) minutes in zone 2, but exceeded recommendations in zone 3 (139 (121-160)) and for patients admitted via the local hospital (219 (171-250)). System delay was an independent predictor of mortality (p<0.001).CONCLUSIONS: Pre-hospital triage is feasible in 73% of patients. PCI-related delay exceeded European Society of Cardiology (ESC) guidelines for patients living >100 km away and for non-directly referred patients. Sorting the PPCI centers catchment area into geographical zones identifies patients with long reperfusion delays. Possible solutions are pharmaco-invasive regiments, research in early ischemia detection, airborne transfer and EMS personnel education that ensures pre-hospital triage.
AB - BACKGROUND: Reperfusion delay in ST-segment elevation myocardial infarction (STEMI) predicts adverse outcome. We evaluated time from alarm call (system delay) and time from first medical contact (PCI-related delay), where fibrinolysis could be initiated, to balloon inflation in a pre-hospital organization with tele-transmitted electrocardiograms, field triage and direct transfer to a 24/7 primary percutaneous coronary intervention (PPCI) center.METHODS AND RESULTS: This was a single center cohort study with long-term follow-up in 472 patients. The PPCI center registry was linked by person identification number to emergency medical services (EMS) and National Board of Health databases in the period of 2005-2008. Patients were stratified according to transfer distances to PPCI into zone 1 (0-25 km), zone 2 (65-100 km) and zone 3 (101-185 km) and according to referral by pre-hospital triage. System delay was 86 minutes (interquartile range (IQR) 72-113) in zone 1, 133 (116-180) in zone 2 and 173 (145-215) in zone 3 (p<0.001). PCI-related delay in directly referred patients was 109 (92-121) minutes in zone 2, but exceeded recommendations in zone 3 (139 (121-160)) and for patients admitted via the local hospital (219 (171-250)). System delay was an independent predictor of mortality (p<0.001).CONCLUSIONS: Pre-hospital triage is feasible in 73% of patients. PCI-related delay exceeded European Society of Cardiology (ESC) guidelines for patients living >100 km away and for non-directly referred patients. Sorting the PPCI centers catchment area into geographical zones identifies patients with long reperfusion delays. Possible solutions are pharmaco-invasive regiments, research in early ischemia detection, airborne transfer and EMS personnel education that ensures pre-hospital triage.
U2 - 10.1177/2048872612455143
DO - 10.1177/2048872612455143
M3 - Journal article
C2 - 24062908
VL - 1
SP - 200
EP - 209
JO - European Heart Journal: Acute Cardiovascular Care
JF - European Heart Journal: Acute Cardiovascular Care
SN - 2048-8726
IS - 3
ER -
ID: 135365597