PMID- 17670756
OWN - NLM
STAT- MEDLINE
DCOM- 20080404
LR  - 20101118
IS  - 0195-668X (Print)
IS  - 0195-668X (Linking)
VI  - 28
IP  - 19
DP  - 2007 Oct
TI  - Field triage to primary angioplasty combined with emergency department bypass 
      reduces treatment delays and is associated with improved outcome.
PG  - 2313-9
AB  - AIMS: We investigated the net benefit in the outcome of reducing treatment delay 
      through field triage and emergency department (ED) bypass in patients with 
      ST-elevation myocardial infarction (STEMI) treated with primary angioplasty. 
      METHODS AND RESULTS: In a prospective registry study, consecutive patients with 
      suspected STEMI were assigned to: (i) pre-hospital ECG and triage or (ii) ECG and 
      triage at the closest ED, solely based on ambulance availability. Four district 
      hospitals and one regional heart centre serviced the 890,000 population 
      metropolitan area and primary angioplasty was the only reperfusion strategy 
      employed. Baseline characteristics were similar in STEMI patients triaged in the 
      field (108) and the EDs (193). Symptom onset to balloon times: 154 
      [inter-quartile range (IQR) 120-233) vs. 249 (IQR 184-405) min (P<0.001) and peak 
      creatine kinase in early presenters (<2 h): 1435 (95 %CI: 904-1966) U/L vs. 2320 
      (95% CI: 1881-2762) U/L (P=0.009) were lower in field- than in ED-triaged 
      patients. Mortality in the PCI treated were 1.1 and 8.2% [P=0.025, RR 0.14 (95% 
      CI: 0.01-1.08)] and overall mortality were 1.9 and 7.3% [P=0.046, RR 0.26 (95% 
      CI: 0.05-1.11)]. CONCLUSION: Field-triage and ED bypass were feasible means of 
      reducing treatment delay in patients with suspected STEMI and resulted in smaller 
      infarct size in early presenters and a trend towards a reduction in mortality.
FAU - Carstensen, Steen
AU  - Carstensen S
AD  - Department of Cardiology, Royal North Shore Hospital, University of Sydney, 
      Australia. sc@dadlnet.dk
FAU - Nelson, Greg C I
AU  - Nelson GC
FAU - Hansen, Peter S
AU  - Hansen PS
FAU - Macken, Lewis
AU  - Macken L
FAU - Irons, Stephen
AU  - Irons S
FAU - Flynn, Michael
AU  - Flynn M
FAU - Kovoor, Pramesh
AU  - Kovoor P
FAU - Soo Hoo, Soon Y
AU  - Soo Hoo SY
FAU - Ward, Michael R
AU  - Ward MR
FAU - Rasmussen, Helge H
AU  - Rasmussen HH
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20070801
PL  - England
TA  - Eur Heart J
JT  - European heart journal
JID - 8006263
SB  - IM
MH  - Aged
MH  - Ambulances
MH  - *Angioplasty, Balloon, Coronary/mortality
MH  - *Coronary Angiography
MH  - *Electrocardiography
MH  - Feasibility Studies
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/mortality/*therapy
MH  - Myocardial Reperfusion/methods
MH  - Prospective Studies
MH  - Time Factors
MH  - Treatment Outcome
MH  - Triage/*organization & administration
EDAT- 2007/08/03 09:00
MHDA- 2008/04/05 09:00
CRDT- 2007/08/03 09:00
PHST- 2007/08/03 09:00 [pubmed]
PHST- 2008/04/05 09:00 [medline]
PHST- 2007/08/03 09:00 [entrez]
AID - ehm306 [pii]
AID - 10.1093/eurheartj/ehm306 [doi]
PST - ppublish
SO  - Eur Heart J. 2007 Oct;28(19):2313-9. doi: 10.1093/eurheartj/ehm306. Epub 2007 Aug 
      1.