Symptom-to-needle times in ST-segment elevation myocardial infarction: Shortest route to a primary coronary intervention facility

Henri Leleu, Frédéric Capuano, Marie Ferrua, Gérard Nitenberg, Etienne Minvielle () and François Schiele
Additional contact information
Henri Leleu: LEM - Lille - Economie et Management - Université de Lille, Sciences et Technologies - CNRS - Centre National de la Recherche Scientifique, IGR - Institut Gustave Roussy
Frédéric Capuano: Dept Food Microbiol - Istituto Zooprofilattico Sperimentale del Mezzogiorno, COMPAQ(HSPT) - U988 - COordination pour la Mesure de la Performance et l'Amélioration de la Qualité ( Hôpital, Patient, Sécurité, Territoire) - IGR - Institut Gustave Roussy - EHESP - École des Hautes Études en Santé Publique [EHESP] - INSERM - Institut National de la Santé et de la Recherche Médicale
Marie Ferrua: IGR - Institut Gustave Roussy, COMPAQ(HSPT) - U988 - COordination pour la Mesure de la Performance et l'Amélioration de la Qualité ( Hôpital, Patient, Sécurité, Territoire) - IGR - Institut Gustave Roussy - EHESP - École des Hautes Études en Santé Publique [EHESP] - INSERM - Institut National de la Santé et de la Recherche Médicale
Gérard Nitenberg: COMPAQ(HSPT) - U988 - COordination pour la Mesure de la Performance et l'Amélioration de la Qualité ( Hôpital, Patient, Sécurité, Territoire) - IGR - Institut Gustave Roussy - EHESP - École des Hautes Études en Santé Publique [EHESP] - INSERM - Institut National de la Santé et de la Recherche Médicale
Etienne Minvielle: IGR - Institut Gustave Roussy, COMPAQ(HSPT) - U988 - COordination pour la Mesure de la Performance et l'Amélioration de la Qualité ( Hôpital, Patient, Sécurité, Territoire) - IGR - Institut Gustave Roussy - EHESP - École des Hautes Études en Santé Publique [EHESP] - INSERM - Institut National de la Santé et de la Recherche Médicale, EA MOS - EA Management des Organisations de Santé - EHESP - École des Hautes Études en Santé Publique [EHESP] - PRES Sorbonne Paris Cité, EHESP - École des Hautes Études en Santé Publique [EHESP]

Post-Print from HAL

Abstract: Background Primary percutaneous coronary intervention (PCI) is the preferred management for patients with acute ST-segment elevation myocardial infarction (STEMI) if performed in a timely manner by experienced providers. Patients can access a PCI facility by three routes: prehospital STEMI diagnosis by emergency medical services (EMS) and direct transport by EMS to a PCI facility (EMS-PCI); visit to a hospital emergency department (ED) followed by referral to an on-site PCI facility (ED-PCI); or transfer from the ED to a PCI facility in another hospital (ED-transfer-PCI). Aims To assess the implementation rate in France of the guidelines recommending that STEMI patients be transported by EMS to a PCI facility and to compare the times between symptom onset and PCI for these three routes. Methods We used the results of the pilot testing of a national quality indicator programme on STEMI in 64 hospitals, providing data on patient characteristics, referral route and symptom-onset-to-needle time. We compared delays for each route in a Cox proportional-hazard model. Results In a population of 1217 patients, median symptom-onset-to-needle time was 186 minutes (Q1 133; Q3 292) for the EMS-PCI route, 237 minutes (Q1 165; Q3 368) for the ED-PCI route and 305 minutes (Q1 230; Q3 570) for the ED-transfer-PCI route. A total of 70.8% of patients were transported by EMS as recommended. After adjustment for age, symptom onset period (weekends/nights) and history of cardiovascular disease, the EMS-PCI route was associated with the shortest symptom-onset-to-needle times. The hazard ratio was 0.71 [0.59–0.86] for the ED-PCI route and 0.67 [0.52–0.86] for the ED-transfer-PCI route. Conclusion STEMI patients receive prompter care after prehospital diagnosis and direct transport to a PCI facility by EMS than by visiting a hospital ED. Use of this referral route should be further encouraged in France as approximately one-third of STEMI patients are still presenting directly to the ED.

Keywords: Prehospital care; Triage; Emergency ambulance systems; Acute myocardial infarct; Infarctus du myocarde; Samu; Filière de prise en charge; Coronarographie (search for similar items in EconPapers)
Date: 2013-02-23
References: Add references at CitEc
Citations:

Published in Archives of cardiovascular diseases, 2013, 106 (3), pp.162 - 168. ⟨10.1016/j.acvd.2012.12.003⟩

There are no downloads for this item, see the EconPapers FAQ for hints about obtaining it.

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-01511235

DOI: 10.1016/j.acvd.2012.12.003

Access Statistics for this paper

More papers in Post-Print from HAL
Bibliographic data for series maintained by CCSD ().