December 01, 2012
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Emergency Transport Directly to a PCI Center Significantly Reduced Mortality

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Emergency transportation of patients with STEMI directly to a primary PCI center yielded a nearly 50% reduction in mortality compared with patients taken to the ER first in a recent study.

Paramedics in Ottawa, Canada, can bypass the emergency room and transport patients with STEMI to a PCI-capable center, allowing researchers to compare the mortality rates for patients taken directly to such a center with those who were not.

In all, 1,389 consecutive patients with STEMI were assessed by paramedics specially trained to interpret 12-point ECGs and then bypass emergency departments and go directly to the PCI center. In this group, 822 patients (59.2%) were referred directly to a PCI center, and 567 (40.8%) were transported to a non-PCI-capable hospital first.  

At 180 days, the rate of mortality was 5% for patients transferred directly from the field and 11.5% for patients transported from the field to a non-PCI-capable hospital (P<.0001). Mortality remained lower among patients referred directly from the field to the PCI center after adjusting for multivariate factors (OR=0.52; 95% CI, 0.31-0.88).

The results support the concept of STEMI systems that include pre-hospital referral by EMS, the researchers noted.

“These data support the position taken by the [American College of Cardiology/American Heart Association] guidelines that every minute counts and that the time to treatment should be ‘as soon as possible,’ rather than simply accepting the standard door-to-balloon of <90 min as satisfactory,” they wrote.

Reference:
Le May M. J Am Coll Cardiol. 2012;60:1223-1230.