Impact of pre-hospital care in patients with acute myocardial infarction compared with those first managed...

Area of Science:

• Cardiology
• Emergency Medicine
• Pre-hospital Care

Background:

• Acute myocardial infarction (AMI) requires rapid intervention.
• Timeliness of treatment significantly impacts patient outcomes.
• Current management often involves initial in-hospital care.

Purpose of the Study:

• To prospectively compare the impact of pre-hospital care by a physician-staffed mobile coronary care unit (MCCU) versus initial in-hospital management for AMI patients.
• To evaluate the effect of pre-hospital MCCU care on in-hospital mortality and treatment delay times.

Main Methods:

• A single-center registry of 750 consecutive AMI patients admitted between 1998 and 2001.
• Comparison of in-hospital mortality and time intervals between symptom onset and treatment for pre-hospital MCCU managed patients versus in-hospital managed patients.
• Analysis of factors associated with adverse in-hospital mortality.

Main Results:

• Overall in-hospital mortality was significantly lower for patients managed pre-hospital (8% vs. 13%, P=0.04).
• Pre-hospital care significantly reduced median delay times for symptom-to-help call, help-to-fibrinolysis, and pain-to-needle times.
• For patients receiving fibrinolytic therapy, in-hospital mortality was lower in the pre-hospital group (7% vs. 13%, P=0.02).
• Older age, hypotension, and higher heart rate were independent predictors of adverse in-hospital mortality.

Conclusions:

• Physician-staffed mobile coronary care unit pre-hospital management of AMI patients is associated with significantly lower in-hospital mortality.
• Early intervention via pre-hospital MCCU care improves treatment timeliness and patient survival.
• Pre-hospital management offers a survival benefit, particularly for AMI patients receiving fibrinolytic therapy.