Praehospital diagnostik og reduktion af behandlingsforsinkelser for patienter med akut ST-elevationsmyokardieinfarkt
Sammanfattning
Patients with acute myocardial infarction and ST-segment-elevation in the electrocardiogram (STEMI) should be treated with primary percutaneous coronary intervention or thrombolysis. The earlier the coronary flow is re-established the greater the prognostic benefit. Based on a systematic literature search, this article reviews international experience with pre-hospital diagnosing and its ability to reduce treatment delays and improve prognosis in patients with STEMI. Thus, pre-hospital diagnosing can reduce delays prior to in-hospital thrombolysis by 20-40 minutes. Treatment delays can be reduced approximately one hour if thrombolysis instead is initiated in the pre-hospital phase. Metaanalyses have estimated that one hour of reduction in treatment delays prior to thrombolytic treatment (from 2.7 to 1.7 hours) can save an extra 15-21 lives per 1000 treated. Among patients transported directly to highly specialized units the optimal treatment is primary percutaneous coronary intervention, in which case pre-hospital diagnosing may reduce treatment delays by approximately 30 minutes. Recent studies have documented beneficial effect if patients with STEMI, admitted to local hospitals, are transferred to highly specialized units for primary percutaneous coronary intervention. No studies have investigated the potential beneficial effect obtained if pre-hospital diagnosing is combined with referral of the latter patients directly to highly specialized units, bypassing the local hospitals.