Background: Timely primary reperfusion decreases morbidity and mortality in patients with ST-segment elevation-myocardial-infarction (STEMI) and is achievable by early diagnosis, rapid triage, and prompt subsequent treatment. The mobile intensive care units (MICU) are ideally suited for this goal. There are limited data describing this unique component of the therapy chain.
Purpose: To characterize the pre-hospital management of STEMI patients enrolled in the nation-wide Acute Coronary Syndromes Israeli (ACSIS ) registry in 2013.
Methods: Baseline characteristics, clinical presentation, pre- and in-hospital therapy, complications and outcomes of all STEMI patients transported by MICUs were compared to those who arrived by regular ambulances (RA) or by self-referral (SR) to the emergency room (ER).
Results: 1644 patients with acute myocardial infarction were enrolled, of whom 539 met the criteria of STEMI and arrived by MICU (59.0%), RA (31.0%) or SR (10.0%). Patients arriving with MICU tended to present with higher Killip class (13.1%) and a higher proportion of out-of-hospital aborted sudden cardiac death (3.8%). They more often required resuscitation (5.7%) and DC-shock (8.3%) upon reaching the ER, but had higher rates of spontaneous reperfusion (12.3%). Compared with the other two groups, patients arriving with MICU received more primary reperfusion therapy (85.2%) and experienced a shorter total ischemic time (median 180 min, IQR 125-300 min). Time from the symptom onset to the first ECG, arrival to ER and door to balloon time were similarly shortened .
Conclusions: Only 59% of STEMI patients were transferred to the hospital by MICU. MICU transportation shortened the total ischemic time compared to self-referral.
