Magnitude of first medical contact in the long-term prognosis of patients treated with STEMI
© BioMed Central Ltd. 2010
Published: 1 March 2010
Numerous STEMI patients are treated successfully in the Central PCI on call system. Up until this time we do not have data about the first medical contact's - National Emergency Service or other medical staff - impact on long-term prognosis. It is also unknown how the method of transport to the PCI center (direct or secondary) influences the prognosis. Our aim was to evaluate the magnitude of first medical contact and the type of transport in the short-term and long-term prognosis.
We evaluated the 30-day and 1-year mortality data of 1,890 consecutive patients who were treated with primary PCI due to STEMI. We selected the patients according to the first medical contact: National Ambulance Service or other medical staff, and according to the type of transport: direct or secondary transport. At the follow-up procedure we used the university's and the National Health Insurance Found's database.
The 1,890 patients' follow-up rate was 100%. First, 34.7% of the patients (656/1,890) called for Emergency Service directly. This rate was even lower in working hours (30.6% - 205/671). It was also observed that as the time delay was increasing from the onset of symptoms, the number of people who called for Emergency Service was lower. Between 10 and 12 hours it was just 12.2% (19/155). Thirty-day mortality (Ambulance Service versus other staff ): 7.3% (48/656) vs 9.5% (117/1232) - P = 0.1. One-year mortality: 12.7% (83/656) vs 16.1% (199/1232) - P = 0.04. Second, 44.4% of the patients (838/1,890) were transported directly to the PCI center (direct transport). Thirty-day mortality (direct versus secondary transport): 60/838 (7.2%) vs 105/1,052 (9.9%); 1-year mortality: 106/838 (12.6%) vs 176/1,052 (16.7%). The difference is significant at 30 days and at 1 year also. The 30-day mortality rate is higher with 24%, the 1-year mortality rate is higher with 15% among those patients who were admitted after a secondary transport.
The long-term prognosis is significantly better among those STEMI patients who are transported directly to the PCI center and where the first medical contact is the National Ambulance Service.