Prehospital activation of cardiac catheterization teams in ST-segment elevation myocardial infarction

Abstract

Introduction and objectives: Current clinical guidelines for ST-segment elevation myocardial infarction (STEMI) suggest prehospital activation of the cardiac catheterization team. In previous protocols in our center activation occurred once patients arrived at the hospital. In January 2011, we initiated a new primary angioplasty activation protocol from prehospital locations. Our objective was to quantify the influence of this change on reperfusion times.

Methods: A total of 173 consecutive STEMI patients (n=73/100 before/after initiation of the new protocol), diagnosed in a prehospital setting within 12 hours of symptom onset, were analyzed. The time between the patient's arrival at the hospital and beginning of the angioplasty procedure was termed the cath lab activation delay.

Results: The new protocol resulted in a 37-min reduction in system delay (166 [132-235] min before vs. 129 [105-166] min after, p<0.001), mostly driven by a 64% reduction in cath lab activation delay (55 [0-79] min before vs. 20 [0-54] min after, p=0.001). This reduction was mainly observed outside working hours. The percentage of patients treated with a system delay ≤ 120 min increased from 14.5% before the new protocol to 41.8% afterwards (p=0.001).

Conclusions: Prehospital activation of the cardiac catheterization team resulted in earlier reperfusion of STEMI patients.

Keywords: Angioplastia coronária; Atraso no tratamento; Coronary angioplasty; Enfarte do miocárdio; Ischemia time; Myocardial infarction; Tempo de isquemia; Treatment delay.