• Roberto Zanini, Marco Aroldi, Silvia Bonatti, Francesca Buffoli, Antonio Izzo, Corrado Lettieri, Michele Romano, Luca Tomasi, and Maria Rosa Ferrari.
• Department of Cardiology, Mantova City Hospital Carlo Poma, Mantova, Italy. cardiomantova@virgilio.it
• J Cardiovasc Med (Hagerstown). 2008 Jun 1;9(6):570-5.

ObjectivesThe aim of the study is to assess, as primary endpoints, in-hospital mortality and percutaneous coronary intervention (PCI) mortality and to compare the outcome in ST elevation myocardial infarction (STEMI) patients with different pathways to a catheterization laboratory in the context of an area with 24 h availability of catheter facilities.MethodsThree hundred and ninety-nine STEMI patients, referred to an interventional centre for primary PCI, were divided into two groups according to the different pathways to the catheterization laboratory. Group A had 263 patients diagnosed following admission to First Aid. Group B had 136 patients diagnosed in a prehospital setting with telemedicine equipment and transferred directly to the interventional centre by advanced life support (ALS) ambulance.ResultsSignificantly shorter treatment delay was observed in group B patients than in group A (262 +/- 112 vs. 148 +/- 81 min in group A vs. B, P < 0.001). A significant reduction in total mortality was observed in group B compared with group A (8.7 vs. 3% in group A vs. B, P < 0.05). After multivariate analysis, predictors of in-hospital mortality are age and Killip class (P < 0.01), different pathways to catheterization laboratory, pre-PCI TIMI flow and onset-to-balloon time (P < 0.05).ConclusionThe present study shows a reduction in treatment delay and in-hospital mortality by prehospital ECG and direct referral to catheterization laboratory.

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