Impact of the Type of First Medical Contact within a Guideline-Conform ST-Elevation Myocardial Infarction Network: A Prospective Observational Registry Study

• Published in: PloS one 2016-06, Vol.11 (6), p.e0156769-e0156769
• Main Authors: Pfister, Roman, Lee, Samuel, Kuhr, Kathrin, Baer, Frank, Fehske, Wolfgang, Hoepp, Hans-Wilhelm, Baldus, Stephan, Michels, Guido
• Format: Article
• Language: English
• Subjects: Aged; Analysis; Balloon angioplasty; Balloon treatment; Biology and Life Sciences; Care and treatment; Cologne; Coronary Angiography; Diagnosis; Electrocardiography; Emergency medical services; Female; Germany; Health aspects; Health services; Heart attack; Heart Rate - physiology; Hospital Mortality; Hospitals; Humans; Logistic Models; Male; Medicine and Health Sciences; Middle Aged; Models, Theoretical; Mortality; Myocardial infarction; Patient outcomes; Patients; People and Places; Percutaneous Coronary Intervention; Practice guidelines (Medicine); Prospective Studies; Registries; Research and Analysis Methods; Risk factors; ST Elevation Myocardial Infarction; Time Factors
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0156769

The impact of type of first medical contact (FMC) in the setting of a guideline conform metropolitan ST-elevation myocardial infarction (STEMI) network providing obligatory primary percutaneous coronary intervention (PCI) is unclear. 3,312 patients were prospectively included between 2006 and 2012 into a registry accompanying the "Cologne Infarction Model" STEMI network, with 68.4% primarily presenting to emergency medical service (EMS), 17.6% to non-PCI-capable hospitals, and 14.0% to PCI-capable hospitals. Median contact-to-balloon time differed significantly by FMC with 89 minutes (IQR 72-115) for EMS, 107 minutes (IQR 85-148) for non-PCI- and 65 minutes (IQR 48-91) for PCI-capable hospitals (p < 0.001). TIMI-flow grade III and in-hospital mortality were 75.7% and 10.4% in EMS, 70.3% and 8.6% in non-PCI capable hospital and 84.4% and 5.6% in PCI-capable hospital presenters, respectively (p both < 0.01). The association of FMC with in-hospital mortality was not significant after adjustment for baseline characteristics, but risk of TIMI-flow grade < III remained significantly increased in patients presenting to non-PCI capable hospitals. Despite differences in treatment delay by type of FMC in-hospital mortality did not differ significantly. The increased risk of TIMI-flow grade < III in patients presenting to non PCI-capable hospitals needs further study.