Urban and rural implementation of prehospital STEMI diagnosis Jacob Thorsted Sorensen, MD Aarhus University Hospital, Skejby Denmark

Background Population: 5.4 mill. Area:43,098 km2 (16,640 sq mi)

Denmark Aalborg Hospital Skejby Hospital Gentofte Hospital Odense Hospital Gentofte Hospital Rigshospitalet

Background

Background Aarhus University Hospital, Skejby: PCI center for 1,200,000 people 800 Primary PCIs/year 2800 PCIs/year in total 8 PCI operators Patients admitted for primary PCI are returned to the local hospital within 8-24 hours

The Danish prehospital strategy All patients transported by the emergency medical services in Denmark have a prehospital ECG recorded if there is: 1) Ongoing chest pain lasting  15 min. 2) Recent chest pain lasting  15 min, within last 12h. 3) New onset dyspnea within 12h, no known lung disease. 4) ”Clinical suspicion” of AMI

The Danish prehospital strategy

The Danish prehospital strategy PCI center ECG

The Danish prehospital strategy PCI center ECG

The Danish prehospital strategy PCI center ECG Interview

The Danish prehospital strategy PCI center If not STEMI: Alerting ECG Interview If STEMI: Re-routing Local hospital

Aims To describe the gradual implementation of prehospital ECG diagnosis in a larger region comprising urban and rural areas To evaluate the impact of prehospital ECG diagnosis on system delay To describe the association between prehospital ECG diagnosis and mortality

Aims To describe the gradual implementation of prehospital ECG diagnosis in a larger region comprising urban and rural areas To evaluate the impact of prehospital ECG diagnosis on system delay To describe the association between prehospital ECG diagnosis and mortality

Aims To describe the gradual implementation of prehospital ECG diagnosis in a larger region comprising urban and rural areas To evaluate the impact of prehospital ECG diagnosis on system delay To describe the association between prehospital ECG diagnosis and mortality

Methods 1049 consecutive STEMI patients from 2004-2007 759 eligible for inclusion (excluded: self-referral, LBBB, symp >12h, not MI) Prehospital or in-hospital ECG diagnosis Patients divided into 3 groups: No prehospital ECG Prehospital ECG, no rerouting Prehospital ECG and rerouting Data from prehospital, in-hospital and national registries.

Results

Results Prehospital dx and direct referral to primary PCI: 78% of STEMI patients EMS-call-to-balloon time: 90 min Door-to-balloon time: 34 min EMS-to-balloon time < 120 min : 86% of patients

Results

Results Regional hospital University Hospital Distance to PCI-center (km) 40 (30-49) 10 (6-19) Time from 911 to balloon 93 min 84 min (p<0.001) Dist. to PCI-center 0-10 km 11-30 km 31-50 km > 50 km Time from 911 to balloon 78 min 89 min 93 min 106 min

Results

Conclusions Prehospital ECG recording: Can be implemented in a larger geographical area Enables patients living far from a PCI center to achieve a system delay comparable to those living close to a PCI center Is associated with a lower all-cause mortality

Conclusions Prehospital ECG recording: Can be implemented in a larger geographical area Enables patients living far from a PCI center to achieve a system delay comparable to those living close to a PCI center Is associated with a lower all-cause mortality

Conclusions Prehospital ECG recording: Can be implemented in a larger geographical area Enables patients living far from a PCI center to achieve a system delay comparable to those living close to a PCI center Is associated with a lower all-cause mortality

Discussion ?