Coronary artery diseaseEffect of Prehospital Triage on Revascularization Times, Left Ventricular Function, and Survival in Patients With ST-Elevation Myocardial Infarction
Section snippets
Methods
This prospective study was conducted from April 15, 2004, to June 30, 2007, and involved a 957-bed tertiary referral center, Westmead Hospital (Sydney, Australia), and 3 community hospitals located 10, 12, and 22 km from Westmead Hospital. The study was conducted within a government-defined area health service and encompassed an area of 762 km2 with a population of 720,000. Westmead Hospital was the only hospital with cardiac catheterization laboratory facilities and on-site cardiac surgical
Results
During the study period, there was a total of 1,449 ETAMI transmissions from ambulances with ETAMI capability. They were received and read in the emergency department of Westmead Hospital. Of these, 183 were interpreted as STEMI and taken to the catheterization laboratory, with 163 confirmed as true STEMI on angiogram. There were no deaths in the ambulance of patients with ETAMI bypassing community hospitals; 7 patients had successful cardioversion in the ambulance for ventricular fibrillation.
Discussion
This study has demonstrated that the decrease in symptom-to-reperfusion times achieved through field triage resulted in better LV function and improved postdischarge survival in patients treated with primary angioplasty for acute STEMI. The relation between symptom-to-reperfusion time and mortality was confirmed in our study with multivariable analysis. Within the confines of our current system, the only effective method of achieving benchmark revascularization times was through the use of
Acknowledgment
We are indebted to all the junior doctors, registrars, interventional fellows, cardiologists, nurses, cardiac technicians, and radiographers in the cardiac catheterization laboratories and wards at Westmead, Blacktown, Mt. Druitt, and Auburn hospitals. We thank our research team, Fiona Cox, Anne-Marie Gerke, Harshini Sivaramakrishnan, and biomedical statistician Karen Byth. We acknowledge the technical support provided by Steve Blake of Medtronic, Minneapolis, Minnesota.
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2018, Egyptian Heart JournalCitation Excerpt :Recently, increasing attention has been devoted to diastolic function after AMI,8 and there is growing evidence indicating a strong association between diastolic dysfunction and adverse outcome. Shorter reperfusion times lead to better outcomes in patients with ST-elevation myocardial infarction.9 The incidence of diastolic dysfunction increases if longer time is required to achieve flow because of increased myocardial stiffness.