Patients transported directely to an intervention center with a pre-hospital notification of the cath lab after ambulance-based diagnosis of STEMI were three times more likely to be treated within the time window of the guidelines, new study data indicated.

Researchers from the Netherlands studied consecutive pre-hospital patients with STEMI who were referred to an intervention center for primary angioplasty from 2005 to 2007. Patients were either directly transported to the intervention center or referred through a nonintervention center, depending on pre-hospital admission diagnosis, whereas the cath lab was activated before transport.

Of the patients (n=581) with suspected STEMI, 454 (78%) arrived via direct transport and 127 (22%) through a nonintervention center. Those directly transported had a higher likelihood of being treated within the 90-minute STEMI guideline window (82% vs. 23%), a shorter median symptom-to-balloon time of 149 minutes vs. 219 minutes and a lower 1-year mortality rate (7% vs. 13%). Additionally, “Direct transport to the intervention center was independently associated with the symptom-to-balloon time, which in turn was an independent predictor of post-procedural thrombolysis in myocardial infarction flow grade 3, a strong prognosticator of outcome,” the researchers wrote.

“Pre-hospital diagnosis of STEMI with direct notification of the catheterization laboratory and subsequent transportation to the intervention center is an attractive treatment strategy,” they wrote. “Our data underscore that efforts should be made to organize a large-scale implementation of an infrastructure of pre-hospital diagnosis and direct transport to the intervention center, with early notification of the catheterization laboratory from the ambulance.”

Alice K. Jacobs, MD, and Claudia P. Hochberg, MD, both of the cardiology section in the department of medicine at Boston Medical Center, wrote in an editorial accompanying the study that these findings are of interest, as systems of care for STEMI patients, which include point-of-entry destination protocols, are being developed to increase the number of patients with timely access to primary percutaneous coronary intervention.

“This study suggests that development of systems that allow pre-hospital identification and triage of STEMI directly to PCI centers improves both process measures and outcomes and provides an opportunity to emphasize the importance of pre-hospital initiatives in the delivery of timely reperfusion therapy,” they wrote.

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