Reduction of treatment delay in patients with ST-elevation myocardial infarction: impact of pre-hospital diagnosis and direct referral to primary percutanous coronary intervention

Terkelsen, Christian Juhl; Lassen, Jens Flensted; Nørgaard, Bjarne Linde; Gerdes, Jens Christian; Poulsen, Steen Hvitfeldt; Bendix, Kristoffer; Ankersen, Jens Peter; Gøtzsche, Liv Bjørn-Hansen; Rømer, Frode K.; Nielsen, Torsten Toftegaard; Andersen, Henning

doi:10.1093/eurheartj/ehi100

Cited by 207 publications

(98 citation statements)

References 39 publications

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“…The second study reported an 11% in-hospital mortality for STEMI patients brought by EMS without a prehospital ECG versus 5% in those with a prehospital ECG. 657 …”

Section: Consensus On Sciencementioning

confidence: 99%

“…Eight studies demonstrated a reduction in the reperfusion delay (with varied time interval definitions) ranging from 15 to 65 minutes in patients treated with PCI (LOE 2 [655][656][657][658] ; LOE 3 112,659,660 ; LOE 4 661 ).…”

Section: Consensus On Sciencementioning

confidence: 99%

“…660 Two nonrandomized trials reported no significant reductions in mortality with the use of prehospital ECGs (LOE 2). 117,657 In one of these studies in-hospital all-cause mortality was 15.6% in a group of STEMI patients brought by EMS to the ED without prehospital ECGs, and 8.4% for patients who had a prehospital ECG and were brought directly to the critical care unit for fibrinolysis. 117 The study was not powered to detect a mortality difference.…”

Section: Consensus On Sciencementioning

confidence: 99%

“…Thirteen studies suggested equivalent outcomes between a strategy of transfer for PPCI and of fibrinolysis in the prehospital or hospital setting, particularly in patients presenting early after the onset of chest pain (Ͻ2 hours) and in certain clinical subsets (Ͻ65 years-of-age, anterior STEMI) (LOE 2 657,677 ; LOE 4 405,450,456,487,[701][702][703][704][705][706][707] ; LOE 5 525 ).…”

Section: Consensus On Sciencementioning

confidence: 99%

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Part 9: Acute Coronary Syndromes

Bossaert

O’Connor²,

Arntz³

et al. 2010

Circulation

103

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These experts reviewed 25 topics related to the acute initial management of acute coronary syndrome (ACS), which was further categorized as unstable angina, non-ST-elevation MI (UA/NSTEMI) and ST-elevation MI (STEMI). Topics were identified based on previous recommendations, emerging science, and clinical importance, using an iterative writing process involving all Task Force members. The Task Force reviewed the evidence specifically related to diagnosis and treatment of ACS in the out-ofhospital setting and the first hours of care in the in-hospital setting, typically in the emergency department (ED). The evidence review took place over several years, with ongoing refinement of recommendations being made as new evidence was published. The purpose of the review was to generate current, evidence-based treatment recommendations for healthcare providers who serve as the initial point of contact for patients with signs and symptoms suggestive of ACS.The following is a summary of the most important changes in recommendations for diagnosis and treatment of ACS since the last ILCOR review in 2005. 1,2• The history and physical examination, initial ECG, and initial serum biomarkers, even when used in combination, cannot be used to reliably exclude ACS in the prehospital and ED settings.• In contrast, chest pain observation protocols are useful in identifying patients with suspected ACS and patients who require admission or may be referred for provocative testing for coronary artery disease (CAD) to identify reversible ischemia. Such strategies also reduce cost by reducing unnecessary hospital admissions and improve patient safety through more accurate identification of NSTEMI and STEMI.• The acquisition of a prehospital 12-lead ECG is essential for identification of STEMI patients before hospital arrival and should be used in conjunction with pre-arrival hospital notification and concurrent activation of the catheter laboratory.• Nonphysicians can be trained to independently interpret 12-lead ECGs for the purpose of identifying patients with STEMI, provided that appropriate and reliable STEMI criteria are used. This skill is of particular value in the prehospital setting where paramedics may independently identify STEMI, thus mitigating over-reliance on ECG transmission.• Computer-assisted ECG interpretation can be used to increase diagnostic accuracy of STEMI diagnosis when used alone or in combination with ECG interpretation by a trained healthcare provider.• STEMI systems of care can be implemented to improve the time to treatment. The following measures have been shown to reduce the time to primary percutaneous coronary intervention (PPCI): institutional commitment, use of a team-based approach, arranging single-call activation of the catheterization laboratory by the emergency physician or prehospital provider, requiring the catheterization laboratory to be ready in 20 minutes, having an experienced cardiologist always available, and providing real-time data feedback.• Intravenous (IV) ␤-blockers should not be give...

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“…The second study reported an 11% in-hospital mortality for STEMI patients brought by EMS without a prehospital ECG versus 5% in those with a prehospital ECG. 657 …”

Section: Consensus On Sciencementioning

confidence: 99%

Section: Consensus On Sciencementioning

confidence: 99%

Section: Consensus On Sciencementioning

confidence: 99%

Section: Consensus On Sciencementioning

confidence: 99%

See 2 more Smart Citations

Part 9: Acute Coronary Syndromes

Bossaert

O’Connor²,

Arntz³

et al. 2010

Circulation

103

View full text Add to dashboard Cite

show abstract

“…Coronary artery disease provides an ideal target for telehealth intervention because of its great and increasing financial cost, and the overrepresentation of heart disease in rural and remote communities (Hooper et al, 2001). The major purpose of pre-hospital 12-lead ECG diagnosis is the early detection of acute myocardial infarction with ST-segment elevation and the communication of that information to the receiving emergency physician before the arrival of the patient (Terkelsen et al, 2005). Transmission of prehospital 12-lead ECG directly to the attending cardiologist's mobile telephone decreased door-to-device time by >1 hour when patients with ST-elevation myocardial infarction were transported directly to invasive centres, bypassing local hospitals (Sejersten et al, 2008).…”

Section: Telecardiologymentioning

confidence: 99%