Predictors of the reduction of treatment time for ST-segment elevation myocardial infarction in a complex urban reality. The MoMi2 survey
Tuesday 22nd April 2008
Grieco, Niccolò; Corrada, Elena; Sesana, Giovanni; Fontana, Giancarlo; Lombardi, Federico; Ieva, Francesca; Paganoni, Anna Maria; Marzegalli, Maurizio
Aims: To achieve a rapid and effective reperfusion of infarct related artery in a complex urban reality. Methods and results: A net that connects the territory to 23 hospitals, by a centralized coordination of the emergency resources has been activated in the Milan urban area to obtain a real time knowledge of critical resources availability and to transmit a 12 lead ECG to the admitting Coronary Care Unit. During the survey periods, data related to 627 patients have been collected. Most of the patients (73%) were treated with primary PCI, 45 (7%) with thrombolysis, 105 (17%) didn’t receive any reperfusion therapy. 57% patients arrived to hospital with rescue units; in 23% of all cases, a 12 lead ECG was tele-transmitted to the hospital of destination before patient arrival. The modality of hospital presentation was the most critical determinant of door-to-balloon time. The shorter one (49.5 minutes) was that of patients transported by means of Advanced Rescue Units with 12 lead ECG tele-transmission and activation of a fast track directly to the Cath Lab. Conclusions: Pre-hospital ECG recording is the most critical factor necessary to keep door-toballoon time within suggested limits in a large urban area where most of STEMI patients are treated with PCI.