PMID- 24062908
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20130924
LR  - 20211021
IS  - 2048-8726 (Print)
IS  - 2048-8734 (Electronic)
IS  - 2048-8726 (Linking)
VI  - 1
IP  - 3
DP  - 2012 Sep
TI  - Reperfusion delay in patients treated with primary percutaneous coronary 
      intervention: insight from a real world Danish ST-segment elevation myocardial 
      infarction population in the era of telemedicine.
PG  - 200-9
LID - 10.1177/2048872612455143 [doi]
AB  - BACKGROUND: Reperfusion delay in ST-segment elevation myocardial infarction 
      (STEMI) predicts adverse outcome. We evaluated time from alarm call (system 
      delay) and time from first medical contact (PCI-related delay), where 
      fibrinolysis could be initiated, to balloon inflation in a pre-hospital 
      organization with tele-transmitted electrocardiograms, field triage and direct 
      transfer to a 24/7 primary percutaneous coronary intervention (PPCI) center. 
      METHODS AND RESULTS: This was a single center cohort study with long-term 
      follow-up in 472 patients. The PPCI center registry was linked by person 
      identification number to emergency medical services (EMS) and National Board of 
      Health databases in the period of 2005-2008. Patients were stratified according 
      to transfer distances to PPCI into zone 1 (0-25 km), zone 2 (65-100 km) and zone 
      3 (101-185 km) and according to referral by pre-hospital triage. System delay was 
      86 minutes (interquartile range (IQR) 72-113) in zone 1, 133 (116-180) in zone 2 
      and 173 (145-215) in zone 3 (p<0.001). PCI-related delay in directly referred 
      patients was 109 (92-121) minutes in zone 2, but exceeded recommendations in zone 
      3 (139 (121-160)) and for patients admitted via the local hospital (219 
      (171-250)). System delay was an independent predictor of mortality (p<0.001). 
      CONCLUSIONS: Pre-hospital triage is feasible in 73% of patients. PCI-related 
      delay exceeded European Society of Cardiology (ESC) guidelines for patients 
      living >100 km away and for non-directly referred patients. Sorting the PPCI 
      centers catchment area into geographical zones identifies patients with long 
      reperfusion delays. Possible solutions are pharmaco-invasive regiments, research 
      in early ischemia detection, airborne transfer and EMS personnel education that 
      ensures pre-hospital triage.
FAU - Schoos, Mikkel M
AU  - Schoos MM
AD  - Department of Cardiology, Copenhagen University Hospital, Denmark.
FAU - Sejersten, Maria
AU  - Sejersten M
FAU - Hvelplund, Anders
AU  - Hvelplund A
FAU - Madsen, Mette
AU  - Madsen M
FAU - Lonborg, Jacob
AU  - Lonborg J
FAU - Steinmetz, Jacob
AU  - Steinmetz J
FAU - Treschow, Philip M
AU  - Treschow PM
FAU - Pedersen, Frants
AU  - Pedersen F
FAU - Jorgensen, Erik
AU  - Jorgensen E
FAU - Grande, Peer
AU  - Grande P
FAU - Kelbaek, Henning
AU  - Kelbaek H
FAU - Clemmensen, Peter
AU  - Clemmensen P
LA  - eng
PT  - Journal Article
PL  - England
TA  - Eur Heart J Acute Cardiovasc Care
JT  - European heart journal. Acute cardiovascular care
JID - 101591369
PMC - PMC3760540
OTO - NOTNLM
OT  - Acute myocardial infarction
OT  - STEMI
OT  - pre-hospital triage
OT  - primary PCI
OT  - reperfusion delay
OT  - telemedicine
COIS- Conflict of interest: None declared
EDAT- 2013/09/26 06:00
MHDA- 2013/09/26 06:01
PMCR- 2012/09/01
CRDT- 2013/09/25 06:00
PHST- 2012/05/15 00:00 [received]
PHST- 2012/06/27 00:00 [accepted]
PHST- 2013/09/25 06:00 [entrez]
PHST- 2013/09/26 06:00 [pubmed]
PHST- 2013/09/26 06:01 [medline]
PHST- 2012/09/01 00:00 [pmc-release]
AID - 10.1177_2048872612455143 [pii]
AID - 10.1177/2048872612455143 [doi]
PST - ppublish
SO  - Eur Heart J Acute Cardiovasc Care. 2012 Sep;1(3):200-9. doi: 
      10.1177/2048872612455143.