Implementation of guidelines for the treatment of acute ST-elevation myocardial infarction: the Cologne Infarction
Markus Flesch1, Jens Hagemeister, Hans-Joerg Berger
1Klinik III für Innere Medizin, Universitaet zu Koeln, Kerpener Strasse 62, 50937 Cologne, Germany. markus.flesch@uni-koeln.de
Insights
The Cologne Infarction Model demonstrates that immediate percutaneous coronary intervention is feasible for ST-elevation myocardial infarction (STEMI) patients in a large city. This approach achieved excellent ECG diagnosis and rapid treatment times, improving patient outcomes.
Area of Science:
- Cardiology
- Emergency Medicine
- Public Health
Background:
- Assessing the feasibility of a standardized treatment pathway for ST-elevation myocardial infarction (STEMI) in a metropolitan area.
- Evaluating the effectiveness of first-line percutaneous coronary intervention (PCI) for STEMI management.
Purpose of the Study:
- To examine the feasibility of obligatory primary percutaneous coronary intervention (PCI) for ST-segment-elevation myocardial infarction (STEMI) within the Cologne (Köln) metropolitan region.
- To assess treatment times and outcomes associated with this model.
Main Methods:
- The Cologne Infarction Model (KIM) involved 519 STEMI patients in 2006 across Cologne's healthcare facilities.
- Data collection included patient presentation, transfer pathways, electrocardiogram (ECG) diagnosis by emergency medical services (EMS), and treatment interventions.
- Key metrics measured were time from symptom onset to first medical contact, phone-to-balloon, and door-to-balloon times.
Main Results:
- 93% of STEMI patients underwent coronary angiography, with 409 receiving PCI and 24 undergoing emergency coronary artery bypass graft (CABG).
- Median door-to-balloon time was 49 minutes, and 89% achieved Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow.
- EMS ECG diagnosis accuracy for STEMI was high, with a 6% false-positive rate; in-hospital mortality was 12.1%.
Conclusions:
- The Cologne Infarction Model successfully demonstrated the feasibility of primary PCI for STEMI in a large urban setting.
- The established treatment pathways facilitated timely angiography and intervention for nearly all STEMI patients.
- Excellent EMS ECG competence and treatment times within established limits indicate a high-quality care model.
Background:
The aim of the Köln (Cologne) Infarction Model is to examine the feasibility of obligatory treatment of ST-segment-elevation myocardial infarction (STEMI) by first-line percutaneous coronary intervention.
Methods And Results:
The study was performed in Cologne with >1 million citizens, 5 coronary intervention centers, and 11 primary care hospitals. Twelve-lead ECG was available for all emergency medical service (EMS) teams. Partners guaranteed direct transfer of STEMI patients to a catheterization laboratory. A total of 519 patients treated within KIM in 2006 were included in the study. Of these, 24% presented at a primary care hospital, 11% presented directly at a coronary intervention center, 5% were transferred by EMS to primary care hospitals, and 60% were directly transferred by EMS to a catheterization laboratory. In 91% of cases, the catheterization laboratory was notified of the patient's arrival in advance. False-positive ECG diagnosis of STEMI by EMS accounted for 6%. Median treatment times were as follows: from the start of symptoms to first medical contact, 120 minutes; phone to balloon, 70 minutes; and door to balloon, 49 minutes. Of all patients, 93% underwent angiography; 409 patients were treated by coronary intervention, and 24 underwent emergency coronary artery bypass graft. Thrombolysis in Myocardial Infarction grade 3 flow was obtained in 89%. In the hospitals, deaths and new myocardial infarctions were observed in 12.1% and in 1.9% of all patients, respectively.
Conclusions:
The Cologne Infarction Model provides evidence for the feasibility of obligatory treatment of STEMI by primary coronary intervention in a metropolitan setting. Acceptance of treatment pathways allowed nearly all STEMI patients to undergo coronary angiography. ECG competence of EMS was excellent. Treatment times were within postulated limits. Results, including mortality, were within a high quality range.
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