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Impact of prehospital diagnosis in the management of ST elevation myocardial infarction in the era of primary percutaneous coronary intervention: reduction of treatment delay and mortality

Zanini, Roberto; Aroldi, Marco; Bonatti, Silvia; Buffoli, Francesca; Izzo, Antonio; Lettieri, Corrado; Romano, Michele; Tomasi, Luca; Ferrari, Maria Rosa

Journal of Cardiovascular Medicine: June 2008 - Volume 9 - Issue 6 - p 570–575
doi: 10.2459/JCM.0b013e3282f2c9bd
Original articles

Objectives The aim of the study is to assess, as primary endpoints, in-hospital mortality and percutaneous coronary intervention (PCI) mortality and to compare the outcome in ST elevation myocardial infarction (STEMI) patients with different pathways to a catheterization laboratory in the context of an area with 24 h availability of catheter facilities.

Methods Three hundred and ninety-nine STEMI patients, referred to an interventional centre for primary PCI, were divided into two groups according to the different pathways to the catheterization laboratory. Group A had 263 patients diagnosed following admission to First Aid. Group B had 136 patients diagnosed in a prehospital setting with telemedicine equipment and transferred directly to the interventional centre by advanced life support (ALS) ambulance.

Results Significantly shorter treatment delay was observed in group B patients than in group A (262 ± 112 vs. 148 ± 81 min in group A vs. B, P < 0.001). A significant reduction in total mortality was observed in group B compared with group A (8.7 vs. 3% in group A vs. B, P < 0.05). After multivariate analysis, predictors of in-hospital mortality are age and Killip class (P < 0.01), different pathways to catheterization laboratory, pre-PCI TIMI flow and onset-to-balloon time (P < 0.05).

Conclusion The present study shows a reduction in treatment delay and in-hospital mortality by prehospital ECG and direct referral to catheterization laboratory.

Department of Cardiology, Mantova City Hospital “Carlo Poma”, Mantova, Italy

Received 28 March, 2007

Revised 20 September, 2007

Accepted 1 October, 2007

Correspondence to Dr Roberto Zanini, MD, Department of Cardiology, Mantova City Hospital “Carlo Poma”, Viale Albertoni 1, 46100 Mantova, Italy Tel: +39 376201303; fax: +39 376201970; e-mail:

© 2008 Italian Federation of Cardiology. All rights reserved.