Acute Coronary Syndromes Pre-Hospital Notification of STEMI (PNS): Collaboration between the Victorian Cardiac Clinical Network, Ambulance Victoria and Participating Hospitals.

Abstract

Background: Previous studies have shown that PNS by emergency medical services (EMS) reduces time to reperfusion. PNS was introduced into all PCI capable public and one private hospital in the state of Victoria, Australia in early 2010. We report on the outcomes. Methods: STEMI patients were taken to the nearest PCI-capable hospital with pre-notification via faxing the EKG to the ER or cardiologist for early activation of the Cath Lab. Data was prospectively collected on all PNS patients over the period (Mar 21-Dec 31, 2011). Results: Of the 338 patients triaged, 314 (93%) were taken to the Cath Lab. PCI was performed in 284 (84%). Median D2DT was 54 minutes (IQR 40, 75). In hours D2BT was 44 minutes (IQR 32, 56), out-of-hours was 64 minutes (IQR51, 91). 83% achieved a D2DT of ≤90 minutes. Median symptom onset to first device time (S2DT) was 162 minutes (IQR122, 231). Median EMS contact to device time was 89 minutes (IQR72, 109). 30- day MACE was 7.7% (death 7.1%, recurrent MI 1.1%, TVR 0.7%). Conclusion: PNS on a state-wide basis is feasible and D2BTs are within guideline recommendations. S2DT strongly influences mortality.