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Arch Cardiovasc Dis · Mar 2013
Comparative StudySymptom-to-needle times in ST-segment elevation myocardial infarction: shortest route to a primary coronary intervention facility.
- Henri Leleu, Frédéric Capuano, Marie Ferrua, Gérard Nitenberg, Etienne Minvielle, and François Schiele.
- Projet COMPAQ-HPST, Inserm U988, Institut Gustave-Roussy, 114, rue Édouard-Vaillant, 4(e) étage, 94805 Villejuif cedex, France. Henri.leleu@igr.fr
- Arch Cardiovasc Dis. 2013 Mar 1;106(3):162-8.
BackgroundPrimary percutaneous coronary intervention (PCI) is the preferred management for patients with acute ST-segment elevation myocardial infarction (STEMI) if performed in a timely manner by experienced providers. Patients can access a PCI facility by three routes: prehospital STEMI diagnosis by emergency medical services (EMS) and direct transport by EMS to a PCI facility (EMS-PCI); visit to a hospital emergency department (ED) followed by referral to an on-site PCI facility (ED-PCI); or transfer from the ED to a PCI facility in another hospital (ED-transfer-PCI).AimsTo assess the implementation rate in France of the guidelines recommending that STEMI patients be transported by EMS to a PCI facility and to compare the times between symptom onset and PCI for these three routes.MethodsWe used the results of the pilot testing of a national quality indicator programme on STEMI in 64 hospitals, providing data on patient characteristics, referral route and symptom-onset-to-needle time. We compared delays for each route in a Cox proportional-hazard model.ResultsIn a population of 1217 patients, median symptom-onset-to-needle time was 186minutes (Q1 133; Q3 292) for the EMS-PCI route, 237minutes (Q1 165; Q3 368) for the ED-PCI route and 305minutes (Q1 230; Q3 570) for the ED-transfer-PCI route. A total of 70.8% of patients were transported by EMS as recommended. After adjustment for age, symptom onset period (weekends/nights) and history of cardiovascular disease, the EMS-PCI route was associated with the shortest symptom-onset-to-needle times. The hazard ratio was 0.71 [0.59-0.86] for the ED-PCI route and 0.67 [0.52-0.86] for the ED-transfer-PCI route.ConclusionSTEMI patients receive prompter care after prehospital diagnosis and direct transport to a PCI facility by EMS than by visiting a hospital ED. Use of this referral route should be further encouraged in France as approximately one-third of STEMI patients are still presenting directly to the ED.Copyright © 2013 Elsevier Masson SAS. All rights reserved.
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