Authors: Graham Johnson, Ewan Barron / Codes: CC2, CP1, SLO1, SLO10, SLO3 / Published: 27/09/2022

Authors

Graham Johnson, Ewan Barron

Paper Title

Predictors of hospital prenotification for STEMI and association of prenotification with outcomes

Paper Authors

David Blusztein1, Diem Dinh2, Dion Stub3,4, Luke Dawson1, Angela Brennan2, Christopher Reid5, Karen Smith6, Ziad Nehme6, http://orcid.org/0000-0002-1579-9279Emily Andrew6, Stephen Bernard2,4, Jeffrey Lefkovits1

Link to Paper

emj.bmj.com

What is already known on this subject

Delay to reperfusion in ST-elevation myocardial infarction (STEMI) is detrimental, but can be minimised with prehospital notification by ambulance to the treating hospital

What this study adds

Differences in clinical characteristics, particularly gender, time of presentation and culprit vessel may influence ambulance prenotification. Ambulance cohorts have high-risk features and worse outcomes compared with self-presenters. Improving system inequality in prehospital STEMI diagnosis is recommended for fastest STEMI treatment

Study Design

Retrospective Cohort study of a prospective registry

What was assessed?

First Medical Contact to Balloon times, mortality

Outcomes

Prenotification had shorter FMC-BT but outcomes in terms of mortality where largely the same as no-prenotification and self-presenters

Males were more represented in the pre-notification group

Reduced pre-notification out of hours

Authors’ Conclusion

Differences in clinical characteristics, particularly gender, time of presentation and culprit vessel may influence ambulance prenotification. Ambulance cohorts have high-risk features and worse outcomes compared with self-presenters. Improving system inequality in prehospital STEMI diagnosis is recommended for fastest STEMI treatment

Limitations

Retrospective design, some variation within the study period of 12 lead ECG availability in the pre-hospital setting. 

Our Take Home

 Females present more subtly than males with STEMI

May need to reduce threshold for calling the PCI team out of hours