[Direct referral of patients with ST-elevation acute myocardial infarction to primary percutaneous coronary intervention. Pre-hospital use of telemedicine and risk stratification].

INTRODUCTION

Primary percutaneous coronary intervention (PCI) is recommended for revascularisation of patients with ST-elevation acute myocardial infarction (STEMI) with a duration of symptoms less than 12 hours. Primary PCI is recommended even if the patient is to be transported from a non-invasive hospital to an invasive centre. Normally this transport requires an attending physician. This transport strategy is associated with an increased treatment delay. The aim of this study was to assess pre-hospital tele-transmitted electrocardiogram (tele-ECG) and risk stratification by using a questionnaire in order to assess if selected patients with STEMI can be transported safely to primary PCI without an attending physician.

MATERIALS AND METHODS

Since January 2005 Fyn Svendborg Hospital has received pre-hospital tele-ECG recorded in patients with suspected acute coronary syndrome (ACS) with simultaneous risk stratification by using a questionnaire. Transportable STEMI patients were referred directly to an invasive centre without an attending physician.

RESULTS

During a period of 17 months tele-ECGs were recorded from 1,148 patients. 82 patients had STEMI and 71 patients were transported to an invasive centre without an attending physician. In this group, 1 case of resuscitated ventricular fibrillation was reported. 11 patients were transported to the nearest hospital: 2 to invasive centres, 7 patients were inter-hospital transported with a physician, and transport was not relevant/possible for 2 patients.

CONCLUSION

Pre-hospital tele-ECG and risk stratification can select patients with STEMI and transport them safely to an invasive PCI centre without an attending physician.