The impact of direct admission to a catheterisation lab/CCU in patients with ST-elevation myocardial infarction on the delay to reperfusion and early risk of death: results of a systematic review including meta-analysis

Abstract

BackgroundFor each hour of delay from fist medical contact until reperfusion in ST-elevation myocardial infarction (STEMI) there is a 10% increase in risk of death and heart failure. The aim of this review is to describe the impact of the direct admission of patients with STEMI to a Catheterisation laboratory (cath lab) as compared with transport to the emergency department (ED) with regard to delays and outcome.MethodsDatabases were searched for from April-June 2012 and updated January 2014: 1) Pubmed; 2) Embase; 3) Cochrane Library; 4) ProQuest Nursing and 5) Allied Health Sources. The search was restricted to studies in English, Swedish, Danish and Norwegian languages.The intervention was a protocol-based clinical pre-hospital pathway and main outcome measurements were the delay to balloon inflation and hospital mortality.ResultsMedian delay from door to balloon was significantly shorter in the intervention group in all 5 studies reported. Difference in median delay varied between 16 minutes and 47 minutes.In all 7 included studies the time from symptom onset or first medical contact to balloon time was significantly shorter in the intervention group. The difference in median delay varied between 15 minutes and 1 hour and 35 minutes. Only two studies described hospital mortality. When combined the risk of death was reduced by 37%.ConclusionAn overview of available studies of the impact of a protocol-based pre-hospital clinical pathway with direct admission to a cath lab as compared with the standard transport to the ED in ST-elevation AMI suggests the following. The delay to the start of revascularisation will be reduced. The clinical benefit is not clearly evidence based. However, the documented association between system delay and outcome defends the use of the pathway.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-014-0067-x) contains supplementary material, which is available to authorized users.

Prehospital factors associated with an acute life-threatening condition in non-traumatic chest pain patients — A systematic review

“…Previous reports indicate that patients with ST elevation myocardial infarction (STEMI) benefit from direct admission to a percutaneous coronary intervention laboratory (PCI-lab) by ambulance [11]. Therefore, considerable focus has been directed to the prehospital presence of ST elevation on the prehospital electrocardiogram (ECG).…”

Mortality benefit of primary transportation to a PCI‐capable center persists through an eight‐year follow‐up in patients with ST‐segment elevation myocardial infarction

“…Hagiwara et al searched databases in English, Swedish, Danish, and Norwegian languages for protocol‐based prehospital pathways and main outcome measurements. For each hour of delay from FMC until reperfusion in ST‐elevation myocardial infarction (STEMI) there was a 10% increase in risk of death and heart.…”

Patient healthcare trajectory. An essential monitoring tool: a systematic review

“…Then there is care at admission, medication management [44] and associated costs-here the trajectory concept emerges. There is also an aspect regarding the effectiveness of the measures implemented [46][47][48][49][50][51][52] and the different treatments [53][54][55]. Another investigated aspect concerns lifestyle, with regard to dietary habits, healthy lifestyle [56], comorbidities [43,57] (smoking and/or alcohol), but also environmental factors like atmospheric pollution.…”