Pre-hospital alarm activation for STEMI patients undergoing primary percutaneous coronary intervention in the era of transradial procedures.

Rigamonti, Fabio; Gencer, Baris; Rey, Florian; Chaara, Jawad; Tessitore, Elena; Bunwaree, Sholan; Meier, Pascal; Noble, Stéphane; Grosgurin, Olivier; Larribau, Robert; Windecker, Stephan; Carbone, Federico; Montecucco, Fabrizio; Rodondi, Nicolas; Matter, Christian M; Luscher, Thomas F; Mach, François; Roffi, Marco (2016). Pre-hospital alarm activation for STEMI patients undergoing primary percutaneous coronary intervention in the era of transradial procedures. European journal of internal medicine, 35, pp. 83-88. Elsevier 10.1016/j.ejim.2016.07.002

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BACKGROUND

Transradial access (TRA) improves outcome compared with trans-femoral access for the management of patients with acute coronary syndromes. In this setting, it is unknown whether the activation of a pre-hospital alarm system (PHAS) confers additional benefit for the prognosis of patients with ST-segment elevation myocardial infarction (STEMI).

MATERIALS AND METHODS

We retrospectively analyzed a cohort of patients with a first STEMI who underwent a primary percutaneous coronary intervention (PPCI) at a single center within a prospective cohort of acute coronary syndrome patients (SPUM-ACS). TRA was used in 85% of patients. We assessed how PHAS (n=165) vs. no-PHAS (n=166) activation was associated with the composite outcome of all-cause mortality and recurrence of myocardial infarction (MI) at 1-year follow-up. As secondary outcomes, the individual clinical endpoints were separately assessed for association.

RESULTS

Compared with no-PHAS patients, patients in the PHAS group were predominantly women, and presented more frequently with dyslipidemia and cardiac arrest. A significant reduction in the composite outcome of all-cause mortality and recurrent MI at 1-year was observed in the PHAS group, compared with no-PHAS (3.6% vs. 8.5%, p=0.027). When adjusted for age, sex and resuscitation status, PHAS activation remained associated with decreased all-cause mortality and recurrent MI (HR: 0.36 [95% CI: 0.13-0.95]; p=0.040).

CONCLUSIONS

This study suggests that the benefit of PHAS activation in STEMI patients undergoing PPCI persists also in the era of TRA.

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