Mortality in a Primary and Secondary Transported of STEMI Patients, a Prospective Study

Al Mawiri A.; Stasek J.; Vojáček J.; Bis J.; Albahri Z.

doi:doi:10.11648/j.ajim.20160404.13

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Mortality in a Primary and Secondary Transported of STEMI Patients, a Prospective Study

Al Mawiri A., Stasek J., Vojáček J., Bis J., Albahri Z.

Published in American Journal of Internal Medicine (Volume 4, Issue 4)

Received: 30 June 2016 Accepted: 19 July 2016 Published: 29 July 2016

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Abstract

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.

Published in	American Journal of Internal Medicine (Volume 4, Issue 4)
DOI	10.11648/j.ajim.20160404.13
Page(s)	75-78
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2016. Published by Science Publishing Group

Keywords

STEMI, Prehospital Treatment, Door to Balloon Time and Mortality

References

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[2]	O'Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX, Anderson JL, Jacobs AK, Halperin JL, Albert NM, Brindis RG, Creager MA, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Kushner FG, Ohman EM, Stevenson WG, Yancy CW. 2013 ACCF/AHA guideline for the management of ST elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013; 61(4): e78-140.
[3]	Brodie BR, Stuckey TD, Wall TC, Kissling G, Hansen CJ, Muncy DB, Weintraub RA, Kelly TA. Importance of time to reperfusion for 30-day and late survival and recovery of left ventricular function after primary angioplasty for acute myocardial infarction. J Am Coll Cardiol. 1998; 32(5): 1312-1319.
[4]	Brodie BR, Stone GW, Morice MC, Cox DA, Garcia E, Mattos LA, Boura J, O'Neill WW, Stuckey TD, Milks S, Lansky AJ, GrinesCL. Importance of time to reperfusion on outcomes with primary coronary angioplasty for acute myocardial infarction (results fromthe Stent Primary Angioplasty in Myocardial Infarction Trial). Am J Cardiol. 2001; 88(10): 1085-1090.
[5]	Cannon CP, Gibson CM, Lambrew CT, Shoultz DA, Levy D, French WJ, Gore JM, Weaver WD, Rogers WJ, Tiefenbrunn AJ. Relationship of symptom-onset-to-balloon time and door-to-balloon time with mortality in patients undergoing angioplasty for acute myocardial infarction. JAMA. 2000; 283(22): 2941-2947.
[6]	De Luca G, Suryapranata H, Zijlstra F, van 't Hof AW, Hoorntje JC, Gosselink AT, Dambrink JH, de Boer MJ; ZWOLLE Myocardial Infarction Study. Symptom-onset-to-balloon time and mortality in patients with acute myocardial infarctiontreated by primaryangioplasty. J Am Coll Cardiol. 2003; 42(6): 991-997.
[7]	De Luca G, Suryapranata H, Ottervanger JP, Antman EM. Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts. Circulation. 2004; 109(10): 1223-1225.
[8]	Leleu H, Capuano F, Ferrua M, Nitenberg G, Minvielle E, Schiele F. Symptom-to-needletimes in ST-segment elevationmyocardialinfarction: shortestroute to a primary coronaryinterventionfacility. Arch Cardiovasc Dis. 2013; 106(3): 162-168.
[9]	Fujii T, Naoki MN, Suzuki T, Trii S, Murakami T, Nakano M, Nakazawa G, Shinozaki N, Matsukage T, Ogata N, Yoshimachi F, Ikari Y. Impact of transport pathways on the time from symptom onset of ST- Segment elevation myocardial infarction to Door of coronary intervention facility. J Cardiol. 2014; 64(1): 11-18.
[10]	Dorsch MF, Greenwood JP, Priestley C, Somers K, Hague C, Blaxill JM, Wheatcroft SB, Mackintosh AF, McLenachan JM, Blackman DJ. Direct ambulance admission to the cardiac catheterization laboratory significantly reduces door-to-balloon times in primary percutaneous coronary intervention. Am Heart J. 2008; 155(6): 1054-1058.

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Al Mawiri A., Stasek J., Vojáček J., Bis J., Albahri Z. (2016). Mortality in a Primary and Secondary Transported of STEMI Patients, a Prospective Study. American Journal of Internal Medicine, 4(4), 75-78. https://doi.org/10.11648/j.ajim.20160404.13

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ACS Style

Al Mawiri A.; Stasek J.; Vojáček J.; Bis J.; Albahri Z. Mortality in a Primary and Secondary Transported of STEMI Patients, a Prospective Study. Am. J. Intern. Med. 2016, 4(4), 75-78. doi: 10.11648/j.ajim.20160404.13

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AMA Style

Al Mawiri A., Stasek J., Vojáček J., Bis J., Albahri Z. Mortality in a Primary and Secondary Transported of STEMI Patients, a Prospective Study. Am J Intern Med. 2016;4(4):75-78. doi: 10.11648/j.ajim.20160404.13

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@article{10.11648/j.ajim.20160404.13,
  author = {Al Mawiri A. and Stasek J. and Vojáček J. and Bis J. and Albahri Z.},
  title = {Mortality in a Primary and Secondary Transported of STEMI Patients, a Prospective Study},
  journal = {American Journal of Internal Medicine},
  volume = {4},
  number = {4},
  pages = {75-78},
  doi = {10.11648/j.ajim.20160404.13},
  url = {https://doi.org/10.11648/j.ajim.20160404.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20160404.13},
  abstract = {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.},
 year = {2016}
}

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TY  - JOUR
T1  - Mortality in a Primary and Secondary Transported of STEMI Patients, a Prospective Study
AU  - Al Mawiri A.
AU  - Stasek J.
AU  - Vojáček J.
AU  - Bis J.
AU  - Albahri Z.
Y1  - 2016/07/29
PY  - 2016
N1  - https://doi.org/10.11648/j.ajim.20160404.13
DO  - 10.11648/j.ajim.20160404.13
T2  - American Journal of Internal Medicine
JF  - American Journal of Internal Medicine
JO  - American Journal of Internal Medicine
SP  - 75
EP  - 78
PB  - Science Publishing Group
SN  - 2330-4324
UR  - https://doi.org/10.11648/j.ajim.20160404.13
AB  - 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.
VL  - 4
IS  - 4
ER  -

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Author Information

Al Mawiri A.

Department of Cardiovascular Medicine, Faculty Hospital, Charles University in Hradec Králové, Hradec Králové, Czech Republic
Stasek J.

Department of Cardiovascular Medicine, Faculty Hospital, Charles University in Hradec Králové, Hradec Králové, Czech Republic
Vojáček J.
Bis J.

Department of Cardiovascular Medicine, Faculty Hospital, Charles University in Hradec Králové, Hradec Králové, Czech Republic
Albahri Z.

Department of Pediatrics, Faculty Hospital, Charles University in Hradec Králové, Hradec Králové, Czech Republic

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APA Style

Al Mawiri A., Stasek J., Vojáček J., Bis J., Albahri Z. (2016). Mortality in a Primary and Secondary Transported of STEMI Patients, a Prospective Study. American Journal of Internal Medicine, 4(4), 75-78. https://doi.org/10.11648/j.ajim.20160404.13

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ACS Style

Al Mawiri A.; Stasek J.; Vojáček J.; Bis J.; Albahri Z. Mortality in a Primary and Secondary Transported of STEMI Patients, a Prospective Study. Am. J. Intern. Med. 2016, 4(4), 75-78. doi: 10.11648/j.ajim.20160404.13

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AMA Style

Al Mawiri A., Stasek J., Vojáček J., Bis J., Albahri Z. Mortality in a Primary and Secondary Transported of STEMI Patients, a Prospective Study. Am J Intern Med. 2016;4(4):75-78. doi: 10.11648/j.ajim.20160404.13

Copy | Download

@article{10.11648/j.ajim.20160404.13,
  author = {Al Mawiri A. and Stasek J. and Vojáček J. and Bis J. and Albahri Z.},
  title = {Mortality in a Primary and Secondary Transported of STEMI Patients, a Prospective Study},
  journal = {American Journal of Internal Medicine},
  volume = {4},
  number = {4},
  pages = {75-78},
  doi = {10.11648/j.ajim.20160404.13},
  url = {https://doi.org/10.11648/j.ajim.20160404.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20160404.13},
  abstract = {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.},
 year = {2016}
}

Copy | Download

TY  - JOUR
T1  - Mortality in a Primary and Secondary Transported of STEMI Patients, a Prospective Study
AU  - Al Mawiri A.
AU  - Stasek J.
AU  - Vojáček J.
AU  - Bis J.
AU  - Albahri Z.
Y1  - 2016/07/29
PY  - 2016
N1  - https://doi.org/10.11648/j.ajim.20160404.13
DO  - 10.11648/j.ajim.20160404.13
T2  - American Journal of Internal Medicine
JF  - American Journal of Internal Medicine
JO  - American Journal of Internal Medicine
SP  - 75
EP  - 78
PB  - Science Publishing Group
SN  - 2330-4324
UR  - https://doi.org/10.11648/j.ajim.20160404.13
AB  - 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.
VL  - 4
IS  - 4
ER  -

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