Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2014

Open Access 01-12-2014 | Review

The impact of direct admission to a catheterisation lab/CCU in patients with ST-elevation myocardial infarction on the delay to reperfusion and early risk of death: results of a systematic review including meta-analysis

Authors: Magnus Andersson Hagiwara, Anders Bremer, Andreas Claesson, Christer Axelsson, Gabriella Norberg, Johan Herlitz

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2014

Login to get access

Abstract

Background

For each hour of delay from fist medical contact until reperfusion in ST-elevation myocardial infarction (STEMI) there is a 10% increase in risk of death and heart failure. The aim of this review is to describe the impact of the direct admission of patients with STEMI to a Catheterisation laboratory (cath lab) as compared with transport to the emergency department (ED) with regard to delays and outcome.

Methods

Databases were searched for from April-June 2012 and updated January 2014: 1) Pubmed; 2) Embase; 3) Cochrane Library; 4) ProQuest Nursing and 5) Allied Health Sources. The search was restricted to studies in English, Swedish, Danish and Norwegian languages.
The intervention was a protocol-based clinical pre-hospital pathway and main outcome measurements were the delay to balloon inflation and hospital mortality.

Results

Median delay from door to balloon was significantly shorter in the intervention group in all 5 studies reported. Difference in median delay varied between 16 minutes and 47 minutes.
In all 7 included studies the time from symptom onset or first medical contact to balloon time was significantly shorter in the intervention group. The difference in median delay varied between 15 minutes and 1 hour and 35 minutes. Only two studies described hospital mortality. When combined the risk of death was reduced by 37%.

Conclusion

An overview of available studies of the impact of a protocol-based pre-hospital clinical pathway with direct admission to a cath lab as compared with the standard transport to the ED in ST-elevation AMI suggests the following. The delay to the start of revascularisation will be reduced. The clinical benefit is not clearly evidence based. However, the documented association between system delay and outcome defends the use of the pathway.
Appendix
Available only for authorised users
Literature
1.
Terkelsen CJ, Jensen LO, Tilsted HH, Thaysen P, Ravkilde J, Johnsen SP, Trautner S, Andersen HR, Thuesen L, Lassen JF: Primary percutaneous coronary intervention as a national reperfusion strategy in patients with ST-segment elevation myocardial infarction. Circulation. 2011, 4: 570-576.PubMed
2.
Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Lancet. 1994, 343: 311-322.
3.
Morrison LJ, Verbeek PR, McDonald AC, Sawadsky BV, Cook DJ: Mortality and prehospital thrombolysis for acute myocardial infarction: A meta-analysis. JAMA. 2000, 283: 2686-2692. 10.1001/jama.283.20.2686.CrossRefPubMed
4.
5.
Deeks J, Dinnes J, D’Amico R, Sowden A, Sakarovitch C, Song F, Petticrew M, Altman DG: Evaluating non-randomised intervention studies. Health Technol Assess. 2003, 7: 1-173. 10.3310/hta7270.CrossRef
6.
Burns JM, Hogg KJ, Rae AP, Hillis WS, Dunn FG: Impact of a policy of direct admission to a coronary care unit on use of thrombolytic treatment. Br Heart J. 1989, 61: 322-325. 10.1136/hrt.61.4.322.PubMedCentralCrossRefPubMed
7.
Pell AC, Miller HC, Robertson CE, Fox KA: Effect of “fast track” admission for acute myocardial infarction on delay to thrombolysis. BMJ. 1992, 304: 83-87. 10.1136/bmj.304.6819.83.PubMedCentralCrossRefPubMed
8.
Davis MA, Keerbs A, Hoffman JR, Baraff LJ: Admission decisions in emergency department chest pain patients at Low risk for myocardial infarction: patient versus physician preferences. Ann Emerg Med. 1996, 28: 606-611. 10.1016/S0196-0644(96)70081-1.CrossRefPubMed
9.
Millar-Craig MW, Joy AV, Adamowicz M, Furber R, Thomas B: Reduction in treatment delay by paramedic ECG diagnosis of myocardial infarction with direct CCU admission. Heart. 1997, 78: 456-461. 10.1136/hrt.78.5.456.PubMedCentralCrossRefPubMed
10.
Prasad N, Wright A, Hogg KJ, Dunn FG: Direct admission to the coronary care unit by the ambulance service for patients with suspected myocardial infarction. Heart. 1997, 78: 462-464. 10.1136/hrt.78.5.462.PubMedCentralCrossRefPubMed
11.
Thomas D, Cooper L, Cooper J, Taylor D, Robb A: Direct fast track admission to a coronary care unit. J R Coll Physicians Lond. 1997, 31: 188-191.PubMed
12.
Sandler DA: Paramedic direct admission of heart-attack patients to a coronary-care unit. Lancet. 1998, 352: 1198-10.1016/S0140-6736(05)60536-3.CrossRefPubMed
13.
de Villiers JS, Anderson T, McMeekin JD, Leung RCM, Traboulsi M: Expedited transfer for primary percutaneous coronary intervention: a program evaluation. Can Med Assoc J. 2007, 176: 1833-1838. 10.1503/cmaj.060902.CrossRef
14.
Ostrzycki C, Borowiec-Kocańda A, Zera T, Pieńkowska K, Drop-Dzwonkowska D: Pre-hospital delay of treatment in patients with ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: Experience of cardiac centre located in the vicinity of the centre of Warsaw. Kardiol Pol. 2008, 66: 609-614.PubMed
15.
Zhang FH, Zhang JS, Shen WF, Zhang RY, Qiu JP, Jin HG, Zhang JF, Wang XL, Jiang L, Liao ML, Hu J: Impact of different clinical pathways on outcomes of patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: The RAPID-AMI study. Chin Med J (Engl). 2009, 122: 636-642.
16.
Gary SH, Cheung KT, Lau CC, Chan HL, Chau CH, Wu KL, Cheung CY, Choi MC, Tse TS, Chan KK, Li SK: Primary percutaneous coronary intervention for ST elevation myocardial infarction: performance with focus on timeliness of treatment. Hong Kong Med J. 2010, 16: 347-353.
17.
Sørensen JT, Terkelsen CJ, Nørgaard BL, Trautner S, Hansen TM, Bøtker HE, Lassen JF, Andersen HR: Urban and rural implementation of pre-hospital diagnosis and direct referral for primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction. Eur Heart J. 2011, 32: 430-436. 10.1093/eurheartj/ehq437.CrossRefPubMed
18.
Abrahamyan L, Austin PC, Donovan LR, Tu JV: Standard admission orders can improve the management of acute myocardial infarction. International J Qual Health Care. 2012, 24: 425-432. 10.1093/intqhc/mzs022.CrossRef
19.
Alexandrescu R, Bottle A, Jarman B, Aylin P: Impact of transfer for angioplasty and distance on AMI in-hospital mortality. Acute Card Care. 2012, 14: 5-12. 10.3109/17482941.2012.655291.CrossRefPubMed
20.
Cooper HM, Hedges LV, Valentine JC: The handbook of research synthesis and meta-analysis. 2009, Russell Sage, New York
21.
Carstensen S, Nelson GCI, Hansen PS, Macken L, Irons S, Flynn M, Kovoor P, Soo Hoo SY, Ward MR, Rasmussen HH: Field triage to primary angioplasty combined with emergency department bypass reduces treatment delays and is associated with improved outcome. Eur Heart J. 2007, 28: 2313-2319. 10.1093/eurheartj/ehm306.CrossRefPubMed
22.
Dorsch MF, Greenwood JP, Priestley C, Somers K, Hague C, Blaxill JM, Wheatcroft SB, Mackintosh AF, McLenachan JM, Blackman DJ: Direct ambulance admission to the cardiac catheterization laboratory significantly reduces door-to-balloon times in primary percutaneous coronary intervention. Am Heart J. 2008, 155: 1054-1058. 10.1016/j.ahj.2008.01.014.CrossRefPubMed
23.
Bång A, Grip L, Herlitz J, Kihlgren S, Karlsson T, Caidahl K, Hartford M: Lower mortality after prehospital recognition and treatment followed by fast tracking to coronary care compared with admittance via emergency department in patients with ST-elevation myocardial infarction. Int J Cardiol. 2008, 129: 325-332. 10.1016/j.ijcard.2007.09.001.CrossRefPubMed
24.
Grosgurin O, Plojoux J, Keller P-F, Niquille M, N’Koulou R, Mach F, Sarasin FP, Rutschmann OT: Prehospital emergency physician activation of interventional cardiology team reduces door-to-balloon time in ST-elevation myocardial infarction. Swiss Med Wkly. 2010, 140: 228-232.PubMed
25.
Majumder B, Mavroudis C, Smith C, Coghlan JG, Shiu M, Rakhit RD: Superior outcome with direct catheter laboratory access vs ED-activated primary percutaneous coronary intervention. Am J Emerg Med. 2012, 30: 1118-1124. 10.1016/j.ajem.2011.07.016.CrossRefPubMed
26.
Cheskes S, Turner L, Foggett R, Huiskamp M, Popov D, Thomson S, Sage G, Watson R, Verbeek R: Paramedic contact to balloon in less than 90 minutes: a successful strategy for St-segment elevation myocardial infarction bypass to primary percutaneous coronary intervention in a Canadian emergency medical system. Prehosp Emerg Care. 2011, 15: 490-498. 10.3109/10903127.2011.598613.CrossRefPubMed
27.
Bagai A, Jollis JG, Dauerman HL, Peng SA, Rokos IC, Bates ER, French WJ, Granger CB, Roe MT: Emergency department bypass for ST-segment–elevation myocardial infarction patients identified with a prehospital electrocardiogram: a report from the American heart association mission: lifeline program. Circulation. 2013, 128: 352-359. 10.1161/CIRCULATIONAHA.113.002339.CrossRefPubMed
28.
Bagai AJ, Al-Khalidi HR, Munoz D, Monk L, Roettig ML, Corbett CC, Garvey JL, Wilson BH, Granger CB: Bypassing the emergency department and time to reperfusion in patients with prehospital ST-segment-elevation findings from the reperfusion in acute myocardial infarction in Carolina emergency departments project. Circulation. 2013, 6: 399-406.PubMed
29.
Amit G, Cafri C, Gilutz H, Ilia R, Zahger D: Benefit of direct ambulance to coronary care unit admission of acute myocardial infarction patients undergoing primary percutanoues intervention. Int J Cardiol. 2007, 119: 355-358. 10.1016/j.ijcard.2006.08.009.CrossRefPubMed
30.
Lubovich A, Hamood H, Behar S, Rosenschein U: Bypassing the emergency room to reduce door-to-balloon time and improve outcomes of patients with ST elevation myocardial infarction: the acute coronary syndrome Israeli survey experience. Isr Med Assoc J. 2011, 13: 216-219.PubMed
31.
32.
Terkelsen CJ, Sørensen JT, Maeng M, Jensen LO, Tilsted H-H, Trautner S, Vach W, Johnsen SP, Thuesen L, Lassen JF: System delay and mortality among patients with STEMI treated with primary percutaneous coronary intervention. JAMA. 2010, 304: 763-771. 10.1001/jama.2010.1139.CrossRefPubMed
33.
Terkelsen CJ, Jensen LO, Tilsted H-H, Trautner S, Johnsen SP, Vach W, Bøtker HE, Thuesen L, Lassen JF: Health care system delay and heart failure in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention: follow-up of population-based medical registry data. Ann Intern Med. 2011, 155: 361-367. 10.7326/0003-4819-155-6-201109200-00004.CrossRefPubMed
Metadata
Title
The impact of direct admission to a catheterisation lab/CCU in patients with ST-elevation myocardial infarction on the delay to reperfusion and early risk of death: results of a systematic review including meta-analysis
Authors
Magnus Andersson Hagiwara
Anders Bremer
Andreas Claesson
Christer Axelsson
Gabriella Norberg
Johan Herlitz
Publication date
01-12-2014
Publisher
BioMed Central
DOI
https://doi.org/10.1186/s13049-014-0067-x

Other articles of this Issue 1/2014

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2014 Go to the issue

Original research

The use of transcutaneous CO2 monitoring in cardiac arrest patients: a feasibility study

Original research

How do bacteraemic patients present to the emergency department and what is the diagnostic validity of the clinical parameters; temperature, C-reactive protein and systemic inflammatory response syndrome?

Original research

Incidence of traumatic cervical spine fractures in the Norwegian population: a national registry study

Original research

Interleukin-6 as inflammatory marker referring to multiple organ dysfunction syndrome in severely injured children

Original research

Accidental cold-related injury leading to hospitalization in northern Sweden: an eight-year retrospective analysis

Original research

Horse-related trauma in children and adults during a two year period