IMPACT OF AN EMERGENCY NETWORK FOR STEMI IN PATIENTS WITH DIFFERENT AGE

Background: During ST elevation myocardial infarction (STEMI) early myocardial reperfusion is the target therapy to salvage ischemic myocardium and to improve survival, and new guidelines recommended the implementation with a regional system of STEMI care with the possibility to perform a 12-lead ECG by emergency network medical service (EMS) personnel at the site of the first medical contact (FMC). Although in recent years the mortality from ischemic heart disease has decreased, this decrease in the elderly population is less consistent. The aim of our study was to evaluate the impact of an EMS on the time of reperfusion in the very elderly STEMI patients (aged≥80 years). Material and Methods: From 1 January 2008 to 30 June 2014, 335 STEMI patients were transported by the EMS to our cath-lab to undergo primary angioplasty (PPCI). The protocol included: quick 12- lead ECG acquisition at the scene of event, tele-transmission of prehospital ECG to the coronary care unit (CCU), direct phone communication between on board EMS physician and on-call CCU cardiologist, early notification and activation of the cath-lab team, and direct routing of the patient to the cath-lab for PPCI. Forty-five patients had an age≥80 years (elderly group, mean age 84.4±3.6) and others 290 patients younger where the control group ( mean age 60.4±10.5). Results: STEMI patients with aged≥80 years underwent PPCI with more delay than those in the control group: they had a median door-toballoon time of 61 minutes vs 51 minutes in control group (p = 0.03) and the proportion of STEMI patients treated with PPCI within 90 minutes of arrival at the hospital is significantly less in elderly group ( 66.7%) than control group ( 82.4%, p=0.013). The elderly group had also a longer FMC time (median 111 minutes) than control group (95 minutes, p= 0.002) and a longer total ischemic time ( median 202 minutes , vs 172 minutes p= 0.005). Conclusions: Our study shows that EMS for STEMI patients is less efficient in very elderly than younger patients. Although the reasons for this are not well understood, we think that in the very elderly population the most frequent comorbidities and a higher risk profile can contribute to complicate the intra- hospital management