OBJECTIVE: To study the impact on outcomes of direct admission versus emergency room (ER) admission in patients with ST-segment elevation myocardial infarction (STEMI) DESIGN: Nationwide observational registry of STEMI patients SETTING: 369 intensive care units in France. INTERVENTIONS: Patients were categorised on the basis of the initial management pathway (direct transfer to the coronary care unit or catheterisation laboratory versus transfer via the ER). MAIN OUTCOME MEASURES: Delays between symptom onset, admission and reperfusion therapy. Mortality at five days and one year. RESULTS: Of 1204 patients enrolled, 66.9% were admitted direct and 33.1% via the ER. Bypassing the ER was associated with more frequent use of reperfusion (61.7% v 53.1%; p = 0.001) and shorter delays between symptom onset and admission (244 (interquartile range 158) v 292 (172) min; p < 0.001), thrombolysis (204 (150) v 258 (240) min; p < 0.01), hospital thrombolysis (228 (156) v 256 (227) min, p = 0.22), and primary percutaneous coronary intervention (294 (246) v 402 (312) min; p < 0.005). Five day mortality rates were lower in patients who bypassed the ER (4.9% v 8.6%; p = 0.01), regardless of the use and type of reperfusion therapy. After adjusting for the simplified Thrombolysis in Myocardial Infarction (TIMI) risk score, admission via the ER was an independent predictor of five day mortality (odds ratio 1.67, 95% confidence interval 1.01 to 2.75). CONCLUSIONS: In this observational analysis, bypassing the ER was associated with more frequent and earlier use of reperfusion therapy, and with an apparent survival benefit compared with admission via the ER.
OBJECTIVE: To study the impact on outcomes of direct admission versus emergency room (ER) admission in patients with ST-segment elevation myocardial infarction (STEMI) DESIGN: Nationwide observational registry of STEMI patients SETTING: 369 intensive care units in France. INTERVENTIONS:Patients were categorised on the basis of the initial management pathway (direct transfer to the coronary care unit or catheterisation laboratory versus transfer via the ER). MAIN OUTCOME MEASURES: Delays between symptom onset, admission and reperfusion therapy. Mortality at five days and one year. RESULTS: Of 1204 patients enrolled, 66.9% were admitted direct and 33.1% via the ER. Bypassing the ER was associated with more frequent use of reperfusion (61.7% v 53.1%; p = 0.001) and shorter delays between symptom onset and admission (244 (interquartile range 158) v 292 (172) min; p < 0.001), thrombolysis (204 (150) v 258 (240) min; p < 0.01), hospital thrombolysis (228 (156) v 256 (227) min, p = 0.22), and primary percutaneous coronary intervention (294 (246) v 402 (312) min; p < 0.005). Five day mortality rates were lower in patients who bypassed the ER (4.9% v 8.6%; p = 0.01), regardless of the use and type of reperfusion therapy. After adjusting for the simplified Thrombolysis in Myocardial Infarction (TIMI) risk score, admission via the ER was an independent predictor of five day mortality (odds ratio 1.67, 95% confidence interval 1.01 to 2.75). CONCLUSIONS: In this observational analysis, bypassing the ER was associated with more frequent and earlier use of reperfusion therapy, and with an apparent survival benefit compared with admission via the ER.
Authors: D A Morrow; E M Antman; R P Giugliano; R Cairns; A Charlesworth; S A Murphy; J A de Lemos; C H McCabe; E Braunwald Journal: Lancet Date: 2001-11-10 Impact factor: 79.321
Authors: L Karagounis; S K Ipsen; M R Jessop; K M Gilmore; D A Valenti; J J Clawson; S Teichman; J L Anderson Journal: Am J Cardiol Date: 1990-10-01 Impact factor: 2.778
Authors: W D Weaver; M S Eisenberg; J S Martin; P E Litwin; S M Shaeffer; M T Ho; P Kudenchuk; A P Hallstrom; M D Cerqueira; M K Copass Journal: J Am Coll Cardiol Date: 1990-04 Impact factor: 24.094
Authors: R C Welsh; W Chang; P Goldstein; J Adgey; C B Granger; F W A Verheugt; L Wallentin; F Van de Werf; P W Armstrong Journal: Heart Date: 2005-03-17 Impact factor: 5.994
Authors: Elliott M Antman; Daniel T Anbe; Paul Wayne Armstrong; Eric R Bates; Lee A Green; Mary Hand; Judith S Hochman; Harlan M Krumholz; Frederick G Kushner; Gervasio A Lamas; Charles J Mullany; Joseph P Ornato; David L Pearle; Michael A Sloan; Sidney C Smith; Joseph S Alpert; Jeffrey L Anderson; David P Faxon; Valentin Fuster; Raymond J Gibbons; Gabriel Gregoratos; Jonathan L Halperin; Loren F Hiratzka; Sharon Ann Hunt; Alice K Jacobs Journal: Circulation Date: 2004-08-31 Impact factor: 29.690
Authors: Frans Van de Werf; Diego Ardissino; Amadeo Betriu; Dennis V Cokkinos; Erling Falk; Keith A A Fox; Desmond Julian; Maria Lengyel; Franz-Josef Neumann; Witold Ruzyllo; Christian Thygesen; S Richard Underwood; Alec Vahanian; Freek W A Verheugt; William Wijns Journal: Eur Heart J Date: 2003-01 Impact factor: 29.983
Authors: Giuseppe De Luca; Harry Suryapranata; Felix Zijlstra; Arnoud W J van 't Hof; Jan C A Hoorntje; A T Marcel Gosselink; Jan Henk Dambrink; Menko Jan de Boer Journal: J Am Coll Cardiol Date: 2003-09-17 Impact factor: 24.094
Authors: Evert J P Lamfers; Astrid Schut; Don P Hertzberger; Ton E H Hooghoudt; Pieter W J Stolwijk; Eric Boersma; Maarten L Simoons; Freek W A Verheugt Journal: Am Heart J Date: 2004-03 Impact factor: 4.749
Authors: Ivan Ilic; Ivan Stankovic; Radosav Vidakovic; Vladimir Jovanovic; Alja Vlahovic Stipac; BiIjana Putnikovic; Aleksandar N Neskovic Journal: Int J Cardiovasc Imaging Date: 2015-02-04 Impact factor: 2.357
Authors: Rodrigo Estévez-Loureiro; Angela López-Sainz; Armando Pérez de Prado; Carlos Cuellas; Ramón Calviño Santos; Norberto Alonso-Orcajo; Jorge Salgado Fernández; Jose Manuel Vázquez-Rodríguez; Maria López-Benito; Felipe Fernández-Vázquez Journal: World J Cardiol Date: 2014-06-26
Authors: Karl Heinrich Scholz; Tim Friede; Thomas Meyer; Claudius Jacobshagen; Björn Lengenfelder; Jens Jung; Claus Fleischmann; Hiller Moehlis; Hans G Olbrich; Rainer Ott; Albrecht Elsässer; Stephen Schröder; Christian Thilo; Werner Raut; Andreas Franke; Lars S Maier; Sebastian Kg Maier Journal: Eur Heart J Acute Cardiovasc Care Date: 2018-11-27