Direct Trip to Intervention Center Improves STEMI Outcomes

Pre-hospital diagnosis plus direct transport linked to quicker time to balloon, lower mortality

FRIDAY, July 23 (HealthDay News) -- Pre-hospital triage of ST-segment elevation myocardial infarction (STEMI) with direct transport to an intervention center is associated with decreased symptom-to-balloon time and a lower mortality rate, according to research published in the July issue of the Journal of the American College of Cardiology: Cardiovascular Interventions.

Hendrik-Jan Dieker, M.D., of Radboud University Medical Center in Nijmegen, Netherlands, and colleagues conducted a study of 581 patients with a pre-hospital diagnosis of STEMI who were either directly transported to the researchers' intervention center or referred through a nonintervention center. The researchers sought to quantify the clinical outcomes of different treatment intervals.

During the study period, 78 percent of the intervention center's STEMI patients were directly transported and 22 percent were transferred from a nonintervention center. A significantly higher proportion of the direct transport patients than transfer patients were treated within the recommended 90-minute time frame from arrival (82 versus 23 percent), and those directly transported also had significantly shorter median symptom-to-balloon time (149 versus 219 min). There was also an increased rate of adequate Thrombolysis in Myocardial Infarction grade 3 post-procedural flow in the directly transported group compared to the transfer group (92 versus 84 percent) and lower one-year mortality (7 versus 13 percent).

"Expanding our efforts to target patient and pre-hospital programs, in addition to interhospital and post-STEMI secondary prevention strategies, will improve the comprehensive care and outcomes for all STEMI patients wherever they may reside," write the authors of an accompanying editorial.

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