Prehospital diagnosis speeds PCI for both rural and urban patients
MedWire News: Danish researchers suggest that implementing a system of prehospital diagnosis and direct referral for percutaneous coronary intervention (PCI) allows rural and urban patients with ST-elevation myocardial infarction (STEMI) to achieve comparable reductions in treatment delay.
Jacob Sørensen (Aarhus University Hospital) and team monitored the extent of system-related treatment delay, defined as the delay from first emergency medical services (EMS) contact to balloon inflation, among 759 Danish STEMI patients who received no prehospital diagnosis (n=216) or prehospital diagnosis with or without direct referral (n=543).
Writing in the European Heart Journal, the researchers report that the use of prehospital diagnosis plus direct referral produced a much shorter median system delay than that achieved without prehospital diagnosis or direct referral, at 92 versus 153 minutes, irrespective of the geographic location of each patient's nearest hospital.
Geographic location had little effect on the extent of system delay, say Sørensen and team who found that although patients in rural locations were a median of 30 km further from a PCI center than urban patients, use of prehospital diagnosis and direct referral resulted in a "negligible" 9-minute difference in the median system delay experienced by both groups.
Specifically, patients living in rural areas had a median system delay of 93 minutes, while those in urban areas had an 84-minute delay.
Furthermore, over a follow-up period of 4.3 years, a lower all-cause mortality rate of 18% occurred among patients given prehospital diagnosis and direct referral to a PCI center compared with a rate of 31% among those who did not receive prehospital diagnosis.
A trend for lower cardiovascular mortality rates among patients receiving prehospital diagnosis plus direct referral was also observed, although after adjusting for possible confounding factors, such as gender and comorbidity, this trend became nonsignificant.
"Prehospital diagnosis of STEMI patients can be successfully implemented in a large geographical region covering both urban and rural districts," say Sørensen et al.
They conclude: "Prehospital electrocardiographic diagnosis and direct referral for primary PCI enable patients living far away from a PCI center to achieve a system delay comparable with that observed in patients near a PCI center and may be associated with a lower mortality."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Lauretta Ihonor