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Treating ST elevation myocardial infarction by primary percutaneous coronary intervention, in-hospital thrombolysis and prehospital thrombolysis. An observational study of timelines and outcomes in 625 patients
  1. S McLean1,
  2. S Wild2,3,
  3. P Connor4,
  4. A D Flapan5
  1. 1The Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
  2. 2Public Health Medicine, The University of Edinburgh, Edinburgh, UK
  3. 3Lothian Health Board, Edinburgh, UK
  4. 4The Scottish Ambulance Service, South-East Division, Edinburgh, UK
  5. 5The Edinburgh Heart Centre, NHS Lothian, Edinburgh, UK
  1. Correspondence to S McLean, Barts and The London NHS Trust, The Royal London Hospital, Whitechapel, London E1 1BB, UK; Scott.Mclean{at}bartsandthelondon.nhs.uk

Abstract

Objective To describe the effects of implementing of a percutaneous coronary intervention (PPCI) service and compare the distribution of reperfusion therapies 12 months pre and post introduction of PPCI.

Design Observational study with data collected 12 months pre and post-availability of Primary PCI as routine treatment.

Setting Lothian region in South-East Scotland.

Patients 625 Patients who received reperfusion treatment between December 2005 and November 2007.

Results PHT was given to 96/328 patients (29%) prior to availability of PPCI as routine treatment. Following routine availability, PPCI was delivered to 248/297 patients who received reperfusion treatment (84%). Median diagnosis-to-PCI balloon inflation time and hospital door-to-balloon time were 84 and 54 min, respectively. Patients received PPCI balloon inflation within 90 min of diagnosis in 60% of cases. PPCI-related delay was 74 min compared with prehospital thrombolysis (PHT). PHT (152 min) and PPCI (166 min) had shorter symptom onset-to-assessment of reperfusion times than in-hospital thrombolysis (IHT) (226 min).

Conclusions More than two-thirds of the total-ischaemic-time in (ST-segment elevation myocardial infarction) STEMI occurs before the patient reaches hospital, with less than one-third being accounted for by door-to-needle (IHT) or door-to-balloon (PPCI) time. The magnitude of difference in the time between symptom onset-and-assessment of reperfusion treatment efficacy is short and should be considered, particularly in patients treated with thrombolysis in hospitals without cath-lab facilities. Optimal reperfusion treatment including a combination of PHT, IHT and PPCI, as recommended in international guidelines, is feasible in the UK although the balance between the use of different treatments will differ between urban and rural areas.

  • Cardiac care
  • acute myocardial infarction
  • thrombolysis
  • care systems
  • emergency ambulance systems

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Footnotes

  • Funding Funding for this study was provided by the Chief Scientist Office of the Scottish government Health Department.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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