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Mobile Intensive Care Unit versus Hospital walk-in patients, in the treatment of first episode ST- elevation myocardial infarction

Published:December 21, 2019DOI:https://doi.org/10.1016/j.ejim.2019.12.005

      Highlights

      • A high percentage of patients with symptoms of STEMI still go to Hospital under their on means.
      • Initial attention by EMS was associated with a decrease in the total ischemia time.
      • Patients attended by the MICUs presented a shorter ICU and hospital stay.
      • Mortality at 30-days and 6 months was lower in patients treated by MICU.

      Abstract

      Objective

      To determine the impact of the attention given by emergency medical services teams working in mobile intensive care units (MICU) versus patients arriving at the hospital under their own means with ST-elevation myocardial infarction (STEMI) event in terms of time to reperfusion (TR), mortality at 30 days and six months.

      Methods

      We retrospectively studied 634 consecutive patients with STEMI who underwent primary a percutaneous coronary intervention from January 1st 2015 to December 31st 2018 in a single centre. Depending on the first medical contact patients were classified into two groups, MICU versus walk-in patients. We extracted data on patients’ characteristics, symptoms, treatments, times to reperfusion and mortality.

      Results

      In our study 634 patients were included, of whom 59.0% were initially attended by the MICU. Differences were seen between the two groups in time delays to the first medical contact (120.0 vs 63.0 min; p < 0.001) and TR (208.0 Vs 150.0 min; p < 0.001). Patients attended by the MICUs presented a shorter ICU and hospital stay. The lowest 30-day mortality rate was observed in MICU group: 9.0% in contrast with 4.5%, p = 0.03; remaining after 6 months. The multivariable analysis showed that the initial attention given by MICU to STEMI patients was a protective agent against mortality [OR: 0.32 (0.11–0.90); p = 0.03].

      Conclusion

      Initial attention of the patients with STEMI by doctor-on-board-MICU and available 24 h a day 7 days a week as part of a regional network (CORECAM), was associated with a decrease in the ischemia time, hospital stay and mortality of these patients in our environment.
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      Linked Article

      • Impact of mobile intensive care units on STEMI delays and outcomes–Is it simply a matter of time?
        European Journal of Internal MedicineVol. 73
        • Preview
          Ischemic heart disease (IHD) remains the leading cause of death worldwide [1], regardless of the income level of the country [2]. Mortality trends for IHD slowly but progressively declined over the last decades [1]. This gradual decrease may be explained by a reduced impact of some conditions including smoking and hypertension, by the generally more effective treatment of cardiovascular risk factors, and finally, by the improvement in the management of acute coronary syndromes [1]. Since the release of 2004 Guidelines for the management of patients with ST-elevation myocardial infarction (STEMI) [3], primary percutaneous coronary intervention (PCI) have been chosen as the preferred reperfusion strategy over fibrinolysis, provided that it could be performed in a timely fashion: 120 min is the maximum allowed from the diagnosis of STEMI to primary PCI [4].
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