Analysis of times of emergency service transport of patients to a catheterization laboratory in the first year implementing a code of practice for attending acute ST-elevation myocardial infarction in Asturias

Background and objectives: To assess the degree of compliance with time objectives

for starting a primary percutaneous coronary intervention in Asturias, Spain, and to

determine whether there are differences between patients first treated by prehospital

emergency medical services and taken directly to a catheterization laboratory and those

first taken to hospitals without laboratories.

Methods: Cross-sectional descriptive observational study of cases of acute ST-elevation

myocardial infarction attended by the prehospital emergency services in Asturias in

2012. Cases were classified into 2 groups: in the first were patients taken directly to the

catheterization laboratory (direct route) and in the second, patients first taken to

emergency departments in hospitals without a laboratory (indirect route). We compared

times between the onset of symptoms, first medical contact, activation of the

catheterization laboratory, and balloon inflation in the laboratory.

Results: We analyzed 359 cases (direct route, 238; indirect route, 121). The mean time

between first medical contact and balloon inflation was 88.9 minutes; 87.7% of the

patients were attended within 120 minutes or less (direct route, 93.3%; indirect route,

76.7%). Patients who sought care within 2 hours of onset of symptoms experienced a

mean delay of 87.8 minutes; 58.8% were attended within 90 minutes or less (direct

route, 70.2%; indirect route, 32.3%).

Conclusions: Time objectives are being met in Asturias. The best care scenario is for

patients to be treated at the scene by the prehospital emergency service and taken

directly to a catheterization laboratory. Efforts must be made to advise the population to

call a local emergency number (112 or 061) as soon as chest pain suggests a coronary

event. First responders should make the effort to diagnose the condition and transfer the

patient quickly to a catheterization laboratory.