Direct transport naar interventie centra reduceert diagnose-tot-ballon tijd

Nieuws - 24 aug. 2010

Hendrik-Jan Dieker (St. Radboud Universitair Medisch Centrum, Nijmegen) en zijn team ondervonden dat direct transport een afname van diagnose-to-ballon tijd met ongeveer 50 minuten veroorzaakt.

Transporting patients with ST-elevation myocardial infarction (STEMI) directly to an intervention center produces a three-fold increase in the percentage of patients treated within the optimal 90-minute window currently recommended by the American College of Cardiology, a Dutch study suggests.

Hendrik-Jan Dieker (Radboud University Medical Center, Nijmegen) and team say they also found that direct transportation reduced diagnosis-to-balloon time by about 50 minutes.

They add: “Direct transport resulted in higher rates of post-procedural thrombosis in myocardial infarction (TIMI) flow grade 3, a strong prognosticator of improved long-term survival.”

Dieker and colleagues analyzed the treatment times of 581 patients diagnosed with primary angioplasty-indicated STEMI while en-route to an intervention (n=454) or non-intervention center (n=127).

The findings, published in the Journal of the American College of Cardiology: Cardiovascular Interventions, showed that 82% and 23% of patients transported to an intervention center and to a non-intervention center, respectively, received angioplasty within 90 minutes of first medical contact (p<0.01).

The median symptom-to-balloon time, defined as time from onset of symptoms to initiation of angioplasty, was shorter among the patients transported directly to the intervention center compared with those transported via a non-intervention center, at 149 and 219 minutes, respectively (p<0.01).

Additionally, a higher rate of post-procedural TIMI flow grade 3 and a lower 1-year mortality rate occurred among patients transported directly to the intervention center compared with those transported via a non-intervention center, at 92% versus 84%, and 7% versus 13%, respectively (p=0.03 for both).

“Our data underscore that efforts should be made to organize a large-scale implementation of an infrastructure of pre-hospital diagnosis and direct transport to the intervention center,” Dieker et al conclude.

In an accompanying commentary, Alice Jacobs and Claudia Hochberg (Boston Medical Center, Massachusetts, USA) commented: “It will be important to focus on unaddressed treatment delays before emergency medical services (EMS) arrival including earlier symptom recognition by patients and immediate EMS notification.”

J Am Coll Cardiol Intv 2010; 3: 705–714

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