Heart attack patients taken directly to heart centres for
lifesaving treatment have better long-term survival than those transferred from
another hospital, reports a large observational study presented tat Acute
Cardiovascular Care 2019 a European Society of Cardiology (ESC) congress
in Madrid. Directly admitted patients were older, suggesting that heart attacks
in young adults, and particularly women, go unrecognised by paramedics and
Study author Dr Krishnaraj Rathod, of Barts Health NHS
Trust, London, UK, said: “The age of first heart attacks is getting younger,
one of the reasons is because of lifestyle habits. The average age in our
cohort is no longer 60, but around 40 years and we even see patients in their
30s. Directly admitted patients were sicker but they were also older,
indicating that paramedics may think heart attack is unlikely in younger
adults. My message to them is ‘in cases of doubt, repeat the 12 lead ECG and consider
speaking to the heart attack centre.”
People in their 30s and 40s should not ignore heart attack
symptoms, particularly women who often have atypical symptoms, he said.
“Younger patients likely wait longer to call for help because if they have
chest pain, heart attack is not the first thing they think of. If you are in
any doubt, phone an ambulance.”
The study from the London Heart Attack Group included 25 315
patients with ST-elevation myocardial infarction (STEMI). Rapid opening of the
artery with a stent using primary percutaneous coronary intervention (PCI)
improves survival and guidelines advise taking STEMI patients directly to
a primary PCI centre.
The study compared characteristics, time to primary PCI, and
long-term outcomes of STEMI patients taken directly to a primary PCI hospital
versus those transferred from another hospital. Patients with STEMI were
treated with primary PCI between 2005 and 2015 at the eight primary PCI centres
in London. Patient details were recorded at the time of the procedure in the
British Cardiovascular Intervention Society dataset. Data on all-cause
mortality were obtained from the Office for National Statistics.
A total of 17 580 (69%) patients were admitted directly to
primary PCI centres and 7735 (31%) were transferred from other hospitals. The
time between call for help and first hospital admission was similar between the
two groups. However, the median time from call for help to opening the blocked
artery with primary PCI was 52 minutes longer in transferred patients compared
to those admitted directly.
After a median follow-up of three years, patients
admitted directly to a primary PCI centre were significantly less likely to
have died than those transferred from another hospital (17.4% versus 18.7%).
After adjusting for factors that could influence the risk of death including
age, previous heart attack and diabetes, direct admission to a primary PCI
hospital was associated with a 20% lower risk of all-cause death.
Dr Rathod said: “Our findings indicate that the superior
survival in patients admitted directly to a primary PCI hospital was because
there was a shorter gap between calling for help and receiving treatment.”
“All patients with STEMI should be admitted directly to a
primary PCI centre within 90 minutes of diagnosis by electrocardiogram (ECG),
which is done by ambulance teams,” he said. “Yet in our study nearly one-third
were taken to another hospital first, indicating that a STEMI diagnosis was not
made until patients reached that hospital, and they then had to be transferred.
However, it must be noted that the rates of transfer directly to a primary PCI
centre were better in the later years suggesting better identification of
appropriate patients by healthcare staff.”