Introduction
Pre-hospital activation and direct cardiac catheterisation laboratory (CCL) transfer
of ST segment elevation myocardial infarction (STEMI) has previously been shown to
improve door-to-balloon (DTB) times yet there is limited outcome data in the Australian
context. We aimed to assess the impact of pre-hospital activation on STEMI performance
measures and mortality.
Methods
Prospective cohort study of consecutive ambulance transported STEMI patients treated
with primary percutaneous coronary intervention (PCI) patients over a 10-year period
(1 January 2008–31 December 2017) at The Prince Charles Hospital, a large quaternary
referral centre in Brisbane, Queensland Australia. Comparisons were performed between
patients who underwent pre-hospital CCL activation and patients who did not. STEMI
performance measures, 30-day and 1-year mortality were examined.
Results
Amongst 1,009 patients included (mean age: 62.8 yrs±12.6), pre-hospital activation
increased over time (26.6% in 2008 to 75.0% in 2017, p<0.001). Median DTB time (35
mins vs 76 mins p<0.001) and percentage meeting targets (DTB<60 mins 92% vs 27%, p<0.001)
improved significantly with pre-hospital activation. Pre-hospital activation was associated
with significantly lower 30-day (1.0% vs 3.5%, p=0.007) and 1-year (1.2% vs 7.7%,
p<0.001) mortality. After adjusting for confounders and mediators, we observed a strong
total effect of pre-hospital activation on 1-year mortality (OR 5.3, 95%CI 2.2–12.4,
p<0.001) compared to patients who did not have pre-hospital activation. False positive
rates were 3.7% with pre-hospital activation.
Conclusion
In patients who underwent primary PCI for STEMI, pre-hospital activation and direct
CCL transfer is associated with low false positive rates, significantly reduced time
to reperfusion and lower 30-day and 1-year mortality.
Keywords
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Article info
Publication history
Published online: February 25, 2022
Accepted:
January 13,
2022
Received in revised form:
December 5,
2021
Received:
August 27,
2021
Identification
Copyright
Crown Copyright © 2022 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). All rights reserved.
