PMID- 25201215
OWN - NLM
STAT- MEDLINE
DCOM- 20141216
LR  - 20220408
IS  - 1879-1913 (Electronic)
IS  - 0002-9149 (Linking)
VI  - 114
IP  - 9
DP  - 2014 Nov 1
TI  - Comparison of outcomes of ambulance users and nonusers in ST elevation myocardial 
      infarction.
PG  - 1289-94
LID - S0002-9149(14)01581-1 [pii]
LID - 10.1016/j.amjcard.2014.07.060 [doi]
AB  - In a systematic province-wide evaluation of care and outcomes of ST elevation 
      myocardial infarction (STEMI), we sought to examine whether a previously 
      documented association between ambulance use and outcome remains after control 
      for clinical risk factors. All 82 acute care hospitals in Quebec (Canada) that 
      treated at least 30 acute myocardial infarctions annually participated in a 
      6-month evaluation in 2008 to 2009. Medical record librarians abstracted hospital 
      chart data for consecutive patients with a discharge diagnosis of myocardial 
      infarction who presented with characteristic symptoms and met a priori study 
      criteria for STEMI. Linkage to administrative databases provided outcome data 
      (to 1 year) and co-morbidities. Of 1,956 patients, 1,222 (62.5%) arrived by 
      ambulance. Compared with nonusers of an ambulance, users were older, more often 
      women, and more likely to have co-morbidities, low systolic pressure, abnormal 
      heart rate, and a higher Thrombolysis In Myocardial Infarction risk index at 
      presentation. Ambulance users were less likely to receive fibrinolysis or to be 
      sent for primary angioplasty (78.5% vs 83.2% for nonusers, p = 0.01), although if 
      they did, treatment delays were shorter (p <0.001). The 1-year mortality rate was 
      18.7% versus 7.1% for nonusers (p <0.001). Greater mortality persisted after 
      adjusting for presenting risk factors, co-morbidities, reperfusion treatment, and 
      symptom duration (hazard ratio 1.56, 95% confidence interval 1.30 to 1.87). In 
      conclusion, ambulance users with STEMI were older and sicker than nonusers. 
      Mortality of users was substantially greater after adjustment for clinical risk 
      factors, although they received faster reperfusion treatment overall.
CI  - Copyright (c) 2014 Elsevier Inc. All rights reserved.
FAU - Boothroyd, Lucy J
AU  - Boothroyd LJ
AD  - Cardiology Evaluation Unit, Institut national d'excellence en sante et en 
      services sociaux, Montreal, Quebec, Canada. Electronic address: 
      lucy.boothroyd@inesss.qc.ca.
FAU - Lambert, Laurie J
AU  - Lambert LJ
AD  - Cardiology Evaluation Unit, Institut national d'excellence en sante et en 
      services sociaux, Montreal, Quebec, Canada.
FAU - Segal, Eli
AU  - Segal E
AD  - Emergency Department, Sir Mortimer B. Davis Jewish General Hospital, Montreal, 
      Quebec, Canada; Corporation d'Urgences-sante, Montreal, Quebec, Canada.
FAU - Ross, Dave
AU  - Ross D
AD  - Corporation d'Urgences-sante, Montreal, Quebec, Canada; Services prehospitaliers 
      d'urgence en Monteregie, Longueuil, Quebec, Canada; Departement de medecine 
      prehospitaliere, Hopital Sacre-Coeur de Montreal, Montreal, Quebec, Canada.
FAU - Kouz, Simon
AU  - Kouz S
AD  - Service de cardiologie, Centre hospitalier regional de Lanaudiere, Joliette, 
      Quebec, Canada.
FAU - Maire, Sebastien
AU  - Maire S
AD  - Service de l'urgence, Centre hospitalier affilie universitaire Hotel-Dieu de 
      Levis, Levis, Quebec, Canada.
FAU - Harvey, Richard
AU  - Harvey R
AD  - Service de cardiologie, Centre hospitalier universitaire de Sherbrooke, 
      Sherbrooke, Quebec, Canada.
FAU - Xiao, Yongling
AU  - Xiao Y
AD  - Cardiology Evaluation Unit, Institut national d'excellence en sante et en 
      services sociaux, Montreal, Quebec, Canada.
FAU - Brown, Kevin A
AU  - Brown KA
AD  - Cardiology Evaluation Unit, Institut national d'excellence en sante et en 
      services sociaux, Montreal, Quebec, Canada.
FAU - Nasmith, James
AU  - Nasmith J
AD  - Division of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada.
FAU - Bogaty, Peter
AU  - Bogaty P
AD  - Cardiology Evaluation Unit, Institut national d'excellence en sante et en 
      services sociaux, Montreal, Quebec, Canada; Departement multidisciplinaire de 
      cardiologie, Institut universitaire de cardiologie et de pneumologie de Quebec, 
      Quebec, Canada.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
DEP - 20140812
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
SB  - IM
MH  - Aged
MH  - Ambulances/*statistics & numerical data
MH  - *Electrocardiography
MH  - Emergency Medical Services/*methods/statistics & numerical data
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/diagnosis/epidemiology/*therapy
MH  - Quebec/epidemiology
MH  - Retrospective Studies
EDAT- 2014/09/10 06:00
MHDA- 2014/12/17 06:00
CRDT- 2014/09/10 06:00
PHST- 2014/05/09 00:00 [received]
PHST- 2014/07/18 00:00 [revised]
PHST- 2014/07/18 00:00 [accepted]
PHST- 2014/09/10 06:00 [entrez]
PHST- 2014/09/10 06:00 [pubmed]
PHST- 2014/12/17 06:00 [medline]
AID - S0002-9149(14)01581-1 [pii]
AID - 10.1016/j.amjcard.2014.07.060 [doi]
PST - ppublish
SO  - Am J Cardiol. 2014 Nov 1;114(9):1289-94. doi: 10.1016/j.amjcard.2014.07.060. Epub 
      2014 Aug 12.