Beneficial effects of direct call to emergency medical services in acute myocardial infarction

Objectives: We investigated the impact of an emergency medical services call on the management of acute myocardial infarction, considering time intervals for intervention and revascularization procedures. Methods: Data were prospectively collected from January 2001 to October 2002 from 531 patients hospitalized for myocardial infarction with ST segment elevation and a pre-hospital delay of less than 24 h. Results: Only 26% of patients called the emergency medical services at the onset of symptoms (n=140). Other patients (n=391, 74%) called another medical contact. Baseline characteristics and cardiovascular history were similar in the two groups, except for the percutaneous coronary intervention history (10% in the emergency medical services group versus 4% in the other medical contact group, P<0.05). Time intervals from the onset of symptoms of myocardial infarction to call or to medical intervention, as well as the time interval from medical intervention to hospital admission were significantly shorter in the emergency medical services group. The early reperfusion rate was also significantly greater in the emergency medical services group (77%) compared with the other medical contact group (64%), mainly because of a greater incidence of primary percutaneous coronary intervention (36 versus 26%, P<0.03, respectively). Multivariate analysis adjusted for sex and age showed that less than three medical care providers [odds ratio (OR) 5.042, P<0.001], percutaneous coronary intervention history (OR 2.462, P<0.05), as well as rhythmic disorders (OR 2.105, P<0.05) and complete atrioventricular block (OR 2.757, P<0.05) were independent predictors of emergency medical services care. Conclusion: This study demonstrated that a call to the emergency medical services is underutilized by patients with symptoms of myocardial infarction, and documented the beneficial effects of an emergency medical services call by reducing pre-hospital delays and increasing early revascularization therapies.

[1]  Jeffrey L. Anderson.  Reperfusion in Acute Myocardial Infarction , 2012, Drugs.

[2]  J. Gurwitz,et al.  Duration of, and temporal trends (1994-1997) in, prehospital delay in patients with acute myocardial infarction: the second National Registry of Myocardial Infarction. , 1999, Archives of internal medicine.

[3]  Adam Brown,et al.  Demographic, belief, and situational factors influencing the decision to utilize emergency medical services among chest pain patients. Rapid Early Action for Coronary Treatment (REACT) study. , 2000, Circulation.

[4]  R. Goldberg,et al.  Knowledge of heart attack symptoms in a population survey in the United States: The REACT Trial. Rapid Early Action for Coronary Treatment. , 1998, Archives of internal medicine.

[5]  William J. Rogers,et al.  Use of Emergency Medical Services in Acute Myocardial Infarction and Subsequent Quality of Care: Observations From the National Registry of Myocardial Infarction 2 , 2002, Circulation.

[6]  Á. Avezum,et al.  Practice variation and missed opportunities for reperfusion in ST-segment-elevation myocardial infarction: findings from the Global Registry of Acute Coronary Events (GRACE) , 2002, The Lancet.

[7]  W Klein,et al.  Management of acute coronary syndromes. Variations in practice and outcome; findings from the Global Registry of Acute Coronary Events (GRACE). , 2002, European heart journal.

[8]  M. Morice,et al.  Outcome after combined reperfusion therapy for acute myocardial infarction, combining pre-hospital thrombolysis with immediate percutaneous coronary intervention and stent. , 2001, European heart journal.

[9]  C Lenfant,et al.  Timing is everything: motivating patients to call 9-1-1 at onset of acute myocardial infarction. , 2001, Circulation.

[10]  H A Feldman,et al.  Effect of a community intervention on patient delay and emergency medical service use in acute coronary heart disease: The Rapid Early Action for Coronary Treatment (REACT) Trial. , 2000, JAMA.

[11]  J. Rawles,et al.  Quantification of the benefit of earlier thrombolytic therapy: five-year results of the Grampian Region Early Anistreplase Trial (GREAT). , 1997, Journal of the American College of Cardiology.

[12]  Prehospital thrombolytic therapy in patients with suspected acute myocardial infarction. , 1993, The New England journal of medicine.

[13]  J. Ferrières,et al.  Treatment of acute myocardial infarction by primary coronary angioplasty or intravenous thrombolysis in the "real world": one-year results from a nationwide French survey. , 1999, Circulation.

[14]  F. Sheehan,et al.  Prehospital thrombolysis in acute myocardial infarction. , 1990, The American journal of cardiology.

[15]  Eric Boersma,et al.  Early thrombolytic treatment in acute myocardial infarction: reappraisal of the golden hour , 1996, The Lancet.

[16]  David Antoniucci,et al.  Relation of time to treatment and mortality in patients with acute myocardial infarction undergoing primary coronary angioplasty. , 2002, The American journal of cardiology.

[17]  G. Hanania,et al.  [Therapeutic strategies in acute myocardial infarction. Results of STIM 93 registry]. , 1996, Archives des maladies du coeur et des vaisseaux.

[18]  M. Simoons.  Effect of glycoprotein IIb/IIIa receptor blocker abciximab on outcome in patients with acute coronary syndromes without early coronary revascularisation: the GUSTO IV-ACS randomised trial , 2001, The Lancet.

[19]  D. Cone,et al.  Use of emergency medical services in acute myocardial infarction and subsequent quality of care: Observations from the national registry of myocardial infarction 2 , 2004 .

[20]  P. Touboul,et al.  Primary angioplasty versus prehospital fibrinolysis in acute myocardial infarction: a randomised study , 2002, The Lancet.

[21]  David Brieger,et al.  Extent of, and factors associated with, delay to hospital presentation in patients with acute coronary disease (the GRACE registry). , 2002, The American journal of cardiology.

[22]  R. Écochard,et al.  Characteristics, management, and in-hospital mortality of acute myocardial infarction in the "real world" in France--data from a large unselected cohort of 2,519 consecutive patients in a French region. , 2000, Acta cardiologica.

[23]  E. Mcfadden.  Fibrinolysis and stenting in acute myocardial infarction: newlyweds destined for a 'ménage à trois'? , 2001, European heart journal.