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Impact of mobile intensive care units on STEMI delays and outcomes–Is it simply a matter of time?

Published:February 05, 2020DOI:https://doi.org/10.1016/j.ejim.2020.01.022
      Ischemic heart disease (IHD) remains the leading cause of death worldwide [
      • Nowbar A.N.
      • Gitto M.
      • Howard J.P.
      • Francis D.P.
      • Al-Lamee R
      Mortality from ischemic heart disease.
      ], regardless of the income level of the country [
      • Roth G.A.
      • Johnson C.
      • Abajobir A.
      • Abd-Allah F.
      • Abera S.F.
      • Abyu G.
      • Ahmed M.
      • Aksut B.
      • Alam T.
      • Alam K.
      • Alla F.
      • Alvis-Guzman N.
      • Amrock S.
      • Ansari H.
      • Ärnlöv J.
      • Asayesh H.
      • Atey T.M.
      • Avila-Burgos L.
      • Awasthi A.
      • Banerjee A.
      • Barac A.
      • Bärnighausen T.
      • Barregard L.
      • Bedi N.
      • Belay Ketema E.
      • Bennett D.
      • Berhe G.
      • Bhutta Z.
      • Bitew S.
      • Carapetis J.
      • Carrero J.J.
      • Malta D.C.
      • Castañeda-Orjuela C.A.
      • Castillo-Rivas J.
      • Catalá-López F.
      • Choi J.-.Y.
      • Christensen H.
      • Cirillo M.
      • Cooper Jr., L.
      • Criqui M.
      • Cundiff D.
      • Damasceno A.
      • Dandona L.
      • Dandona R.
      • Davletov K.
      • Dharmaratne S.
      • Dorairaj P.
      • Dubey M.
      • Ehrenkranz R.
      • El Sayed Zaki M.
      • Faraon E.J.A.
      • Esteghamati A.
      • Farid T.
      • Farvid M.
      • Feigin V.
      • Ding E.L.
      • Fowkes G.
      • Gebrehiwot T.
      • Gillum R.
      • Gold A.
      • Gona P.
      • Gupta R.
      • Habtewold T.D.
      • Hafezi-Nejad N.
      • Hailu T.
      • Hailu G.B.
      • Hankey G.
      • Hassen H.Y.
      • Abate K.H.
      • Havmoeller R.
      • Hay S.I.
      • Horino M.
      • Hotez P.J.
      • Jacobsen K.
      • James S.
      • Javanbakht M.
      • Jeemon P.
      • John D.
      • Jonas J.
      • Kalkonde Y.
      • Karimkhani C.
      • Kasaeian A.
      • Khader Y.
      • Khan A.
      • Khang Y.-.H.
      • Khera S.
      • Khoja A.T.
      • Khubchandani J.
      • Kim D.
      • Kolte D.
      • Kosen S.
      • Krohn K.J.
      • Kumar G.A.
      • Kwan G.F.
      • Lal D.K.
      • Larsson A.
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      • Sartorius B.
      • Schutte A.
      • Sepanlou S.
      • Shaikh M.A.
      • Shin M.-.J.
      • Shishehbor M.
      • Shore H.
      • Silva D.A.S.
      • Sobngwi E.
      • Stranges S.
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      • Tabarés-Seisdedos R.
      • Tadele Atnafu N.
      • Tesfay F.
      • Thakur J.S.
      • Thrift A.
      • Topor-Madry R.
      • Truelsen T.
      • Tyrovolas S.
      • Ukwaja K.N.
      • Uthman O.
      • Vasankari T.
      • Vlassov V.
      • Vollset S.E.
      • Wakayo T.
      • Watkins D.
      • Weintraub R.
      • Werdecker A.
      • Westerman R.
      • Wiysonge C.S.
      • Wolfe C.
      • Workicho A.
      • Xu G.
      • Yano Y.
      • Yip P.
      • Yonemoto N.
      • Younis M.
      • Yu C.
      • Vos T.
      • Naghavi M.
      • Murray C
      Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015.
      ]. Mortality trends for IHD slowly but progressively declined over the last decades [
      • Nowbar A.N.
      • Gitto M.
      • Howard J.P.
      • Francis D.P.
      • Al-Lamee R
      Mortality from ischemic heart disease.
      ]. 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 [
      • Nowbar A.N.
      • Gitto M.
      • Howard J.P.
      • Francis D.P.
      • Al-Lamee R
      Mortality from ischemic heart disease.
      ]. Since the release of 2004 Guidelines for the management of patients with ST-elevation myocardial infarction (STEMI) [
      • Antman E.M.
      • Anbe D.T.
      • Armstrong P.W.
      • Bates E.R.
      • Green L.A.
      • Hand M.
      • Hochman J.S.
      • Krumholz H.M.
      • Kushner F.G.
      • Lamas G.A.
      • Mullany C.J.
      • Ornato J.P.
      • Pearle D.L.
      • Sloan M.A.
      • Smith Jr., S.C.
      • Alpert J.S.
      • Anderson J.L.
      • Faxon D.P.
      • Fuster V.
      • Gibbons R.J.
      • Gregoratos G.
      • Halperin J.L.
      • Hiratzka L.F.
      • Hunt S.A.
      • Jacobs A.K.
      American college of cardiology/American heart association task force on practice G. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction–executive summary: a report of the American college of Cardiology/American heart association task force on practice guidelines (Writing committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction).
      ], 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 [
      • Ibanez B.
      • James S.
      • Agewall S.
      • Antunes M.J.
      • Bucciarelli-Ducci C.
      • Bueno H.
      • Caforio A.L.P.
      • Crea F.
      • Goudevenos J.A.
      • Halvorsen S.
      • Hindricks G.
      • Kastrati A.
      • Lenzen M.J.
      • Prescott E.
      • Roffi M.
      • Valgimigli M.
      • Varenhorst C.
      • Vranckx P.
      • Widimsky P
      2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European society of Cardiology (ESC).
      ].
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