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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Article info
Publication history
Published online: December 21, 2019
Accepted:
December 15,
2019
Received in revised form:
December 13,
2019
Received:
October 4,
2019
Identification
Copyright
© 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
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- Impact of mobile intensive care units on STEMI delays and outcomes–Is it simply a matter of time?European Journal of Internal MedicineVol. 73
- PreviewIschemic 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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