Effect of prehospital triage on revascularization times, left ventricular function, and survival in patients with
Gopal Sivagangabalan1, Andrew T L Ong, Arun Narayan
1Cardiology Department, Westmead Hospital, Westmead, NSW, Australia.
Insights
Prehospital triage for ST-elevation myocardial infarction (STEMI) significantly reduces door-to-balloon times, improving left ventricular function and early survival. Faster reperfusion is crucial for better patient outcomes.
Area of Science:
- Cardiology
- Emergency Medicine
- Public Health
Background:
- Timely reperfusion is critical for improving outcomes in ST-elevation myocardial infarction (STEMI).
- Current triage protocols may delay treatment, impacting patient prognosis.
Purpose of the Study:
- To evaluate the effectiveness of prehospital triage with bypass of community hospitals and early cardiac catheterization team activation.
- To assess the impact on revascularization times, left ventricular ejection fraction, and survival rates in STEMI patients.
Main Methods:
- A comparative study involving 624 STEMI patients divided into three triage groups: ambulance field triage, interventional center emergency department, and community hospital emergency departments.
- Analysis of door-to-balloon times, left ventricular ejection fraction, 30-day mortality, and long-term survival up to 30 months.
Main Results:
- Ambulance field triage significantly decreased median door-to-balloon times by 68 minutes compared to community hospitals and 27 minutes compared to interventional centers.
- The field triage group showed the highest left ventricular ejection fraction (52%) and the lowest 30-day mortality (3%).
- Significant differences in long-term survival were observed, with each extra minute from symptom onset to reperfusion associated with increased mortality risk.
Conclusions:
- Prehospital field triage for STEMI patients reduces revascularization times.
- This approach preserves left ventricular function and improves early survival rates.
- Optimizing STEMI patient triage pathways is essential for better clinical outcomes.
Abstract:
Shorter reperfusion times lead to better outcomes in patients with ST-elevation myocardial infarction (STEMI). We assessed the efficacy of prehospital triage with bypass of community hospitals and early activation of the cardiac catheterization team on revascularization times, left ventricular (LV) ejection fraction, and survival. Patients with STEMI (624) were divided into 3 groups determined by site of triage: ambulance field triage (163), interventional center emergency department (202), and 3 community hospital emergency departments (259). Compared with community hospital and interventional center triages, ambulance field triage resulted in a significant median decrease in door-to-balloon times of 68 and 27 minutes, respectively (p <0.001). LV ejection fraction was highest in the field triage group (52 +/- 13%) compared with the interventional center (49 +/- 12%) and community hospital (48 +/- 12%, p = 0.017) groups. Thirty-day mortality was lowest in the ambulance field group (3%) compared with the interventional facility (11%) and community hospital (4%, p = 0.007) groups. There was a significant difference in long-term survival with up to 30-month follow-up among the 3 triage groups (p = 0.041). With time-dependent Cox regression modeling the difference in survival was significant only during the first week after STEMI (p = 0.020). Every extra minute of symptom onset to reperfusion time was associated with a relative risk of long-term mortality of 1.003 (95% confidence interval 1.000 to 1.006, p = 0.027). In conclusion, field triage of patient with STEMI decreased revascularization times, which preserved LV function, and improved early survival.
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