The influence of residential distance on time to treatment in ST-elevation myocardial infarction patients

Abstract

AimsTo evaluate the relation between residential distance and total ischaemic time in patients with acute ST-elevation myocardial infarction (STEMI).MethodsSTEMI patients were transported to the Isala Hospital Zwolle with the intention to perform primary percutaneous coronary intervention PCI (pPCI) from 2004 until 2010 (n = 4149). Of these, 1424 patients (34 %) were referred via a non-PCI ‘spoke' centre (‘spoke’ patients) and 2725 patients (66 %) were referred via field triage in the ambulance (ambulance patients).ResultsA longer residential distance increased median total ischaemic time in ‘spoke’ patients (0–30 km: 228 min, >30-60 km: 235 min, >60-90 km: 264 min, p < 0.001), however not in ambulance patients (0–30 km: 179 min, >30-60 km: 175 min, >60-90 km: 186 min, p = 0.225). After multivariable linear regression analysis, in ‘spoke’ patients residential distance of >30-60 km compared with 0–30 km was not independently associated with ischaemic time; however, a residential distance of >60-90 km (exp (B) = 1.11, 95 % CI 1.01-1.12) compared with 0–30 km was independently related with ischaemic time. In ambulance patients, residential distance of >30-60 and >60-90 km compared with 0–30 km was not independently associated with ischaemic time.ConclusionA longer distance from the patient’s residence to a PCI centre was associated with a small but significant increase in time to treatment in ‘spoke’ patients, however not in ambulance patients. Therefore, referral via field triage in the ambulance did not lead to a significant increase in time to treatment, especially at long distances (up to 90 km).

Do acute myocardial infarction and stroke mortality vary by distance to hospitals in Switzerland? Results from the Swiss National Cohort Study

“…5 Patients with AMI being referred via field triage, a prehospital diagnosis by ambulance staff, direct referral to a hospital being specialised in the treatment of patients with AMI, and short time to presentation at a high-volume primary PCI centre were factors that reduced the time to EMS contact and start of reperfusion therapy as well as improved health outcomes as, for example, survival. [6][7][8][9] The 2008 European guidelines for stroke treatment recommend intravenous thrombolysis within 3 hours of stroke onset. 10 The following year, the treatment window was extended to 4.5 hours.…”

Multivessel revascularisation versus infarct-related artery only revascularisation during the index primary PCI in STEMI patients with multivessel disease: a meta-analysis

“…In addition, no information was available regarding referral method, ambulance versus referring via non-PCI centres, factors that may affect total ischaemic time [ 32 ].…”

STEMI time delays: a clinical perspective

“…This can be measured by mortality and morbidity, but also by monitoring and comparing weaker endpoints as hospital stay, quality of life, preservation of left ventricular function, readmissions, the need for re-interventions, and many more [ 6 ]. A network-oriented approach with triage and diagnosis by paramedics in the ambulance will bypass non-PCI centres in favour of PCI capable centres, and may thus further reduce time delays [ 7 , 8 ]. If timely PCI cannot be accomplished, fibrinolytic therapy should be considered but there still is a large debate on the time delay that is acceptable, before deciding for this option, or when a combination of the two reperfusion modalities should be preferred [ 9 – 11 ].…”