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

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

3. Denmark Aalborg Hospital Skejby Hospital Gentofte Hospital
Odense Hospital
Gentofte Hospital
Rigshospitalet

4. Background

5. 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

6. 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

7. The Danish prehospital strategy

8. The Danish prehospital strategy
PCI center
ECG

9. The Danish prehospital strategy
PCI center
ECG

10. The Danish prehospital strategy
PCI center
ECG
Interview

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

13. 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

14. 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

15. 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

16. 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.

17. Results

18. 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

19. Results

20. 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

21. Results

22. 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

23. 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

24. 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

25. Discussion ?