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Effects of Prehospital Traige and Diagnosis of ST Segment Elevation Myocardial Infarction on Mortality Rate
Reza Alizadeh1, Ziba Aghsaeifard2, Mostafa Sadeghi3
1Department of Anesthesiology and Intensive Care, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran.
Insights
Prehospital diagnosis of ST segment elevation myocardial infarction (STEMI) using emergency medical services (EMS) and telecardiology significantly reduces door-to-balloon time. This approach may positively impact STEMI patient mortality rates.
Area of Science:
- Cardiology
- Emergency Medicine
- Medical Technology
Background:
- ST segment elevation myocardial infarction (STEMI) outcomes are time-dependent.
- Timely diagnosis and management are critical for reducing adverse events and mortality.
- Prehospital emergency medical service (EMS) interventions can influence STEMI patient care pathways.
Purpose of the Study:
- To evaluate the impact of prehospital STEMI diagnosis via EMS on patient mortality.
- To compare outcomes between STEMI patients managed with and without EMS referral.
- To assess the role of telecardiology in prehospital STEMI management.
Main Methods:
- Retrospective analysis of 424 STEMI patients undergoing primary angioplasty.
- Categorization into three groups: no EMS, no PPCI, and EMS with telecardiology.
- Evaluation of door-to-balloon time, mortality (in-hospital, 6-month, 1-year, 3-year), and left ventricular ejection fraction.
Main Results:
- Prehospital diagnosis with telecardiology (Group C) showed the shortest door-to-balloon time (57.78 min) compared to no EMS (Group A: 141.70 min).
- Group C exhibited lower mortality rates across all time points, though not statistically significant.
- Left ventricular ejection fraction was significantly higher in the prehospital diagnosis group (Group C).
Conclusions:
- Prehospital diagnosis of STEMI utilizing EMS and telecardiology significantly reduces door-to-balloon time.
- This approach shows potential for improving short-term and long-term mortality in STEMI patients.
- Telecardiology integration in EMS enhances STEMI patient management efficiency.
Introduction:
Adverse outcomes and mortality associated with STEMI (ST segment elevation myocardial infarction) are associated with the management and diagnosis time. The aim of this study is to evaluate the outcomes of prehospital diagnosis of STEMI via emergency medical service (EMS) on mortality, in comparison to the patients who did not receive EMS.
Methods:
This retrospective study included STEMI patients, who underwent primary angioplasty. The patients were categorized as group A: referred without emergency service, group B: patients who did not receive PPCI and group C: patients referred via ambulance and received telecardiology. Medical records of these patients were evaluated for the diagnosis time, door-to-balloon time, in-hospital, six months, one year and three-year mortality, left ventricular ejection fraction and previous history of cardiovascular conditions and surgeries. The data were recorded and statistically analyzed using SPSS v21.
Results:
Of 424 patients studied, 79 were referred without emergency service (group A), 52 patients did not receive PPCI (group B) and 293 patients were referred via ambulance with telecardiology (group C). Door-to-balloon time was least in group C (57.78 min) compared to group A (141.70 min). In-hospital, six months, one year and three-year mortality was least in group C, however, the difference was not statistically significant. The left ventricular ejection fraction was significantly greater in group C.
Conclusion:
The results of our study indicate that prehospital diagnosis and telecardiology significantly reduce door-to-balloon time in STEMI patients referred for percutaneous intervention and might have an influence on short-term and long-term mortality rates.
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