Reduction in Mortality as a Result of Direct Transport From the Field to a Receiving Center for Primary Percutaneous Coronary Intervention

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:60

Article

Le May, Michel R.¹  Wells, George A.¹  So, Derek Y.¹  Glover, Chris A.¹  Froeschl, Michael¹  Maloney, Justin²  Dionne, Richard²  Marquis, Jean-Francois¹  O'Brien, Edward R.¹  Dick, Alexander¹  Sherrard, Heather L.¹  Trickett, John²  Poirier, Pierre³  Blondeau, Melissa¹  Bernick, Jordan¹  Labinaz, Marino¹ 

[1] Univ Ottawa, Inst Heart, Ottawa, ON, Canada

[2] Univ Ottawa, Ottawa Base Hosp Program, Ottawa, ON, Canada

[3] Ottawa Paramed Serv, Ottawa, ON, Canada

关键词: angioplasty;    mortality;    primary percutaneous intervention;    ST-segment elevation myocardial infarction;   

DOI  :  10.1016/j.jacc.2012.07.008

来源: Elsevier

【 摘 要 】

Objectives This study sought to determine whether mortality complicating ST-segment elevation myocardial infarction (STEMI) was impacted by the design of transport systems. Background It is recommended that regions develop systems to facilitate rapid transfer of STEMI patients to centers equipped to perform primary percutaneous coronary intervention (PCI), yet the impact on mortality from the design of such systems remains unknown. Methods Within the framework of a citywide system where all STEMI patients are referred for primary PCI, we compared patients referred directly from the field to a PCI center to patients transported beforehand from the field to a non-PCI-capable hospital. The primary outcome was all-cause mortality at 180 days. Results A total of 1,389 consecutive patients with STEMI were assessed by the emergency medical services (EMS) and referred for primary PCI: 822 (59.2%) were referred directly from the field to a PCI center, and 567 (40.8%) were transported to a non-PCI-capable hospital first. Death at 180 days occurred in 5.0% of patients transferred directly from the field, and in 11.5% of patients transported from the field to a non-PCI-capable hospital (p < 0.0001. After adjusting for baseline characteristics in a multivariable logistic regression model, mortality remained lower among patients referred directly from the field to the PCI center (odds ratio: 0.52, 95% confidence interval: 0.31 to 0.88, p = 0.01). Similar results were obtained by using propensity score methods for adjustment. Conclusions A STEMI system allowing EMS to transport patients directly to a primary PCI center was associated with a significant reduction in mortality. Our results support the concept of STEMI systems that include pre-hospital referral by EMS. (J Am Coll Cardiol 2012;60:1223-30) (c) 2012 by the American College of Cardiology Foundation

【 授权许可】

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