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Title: Initial complications and factors related to prehospital mortality in acute myocardial infarction with ST segment elevation.
Authors: Rosell-Ortiz, Fernando
Mellado-Vergel, Francisco J
Fernández-Valle, Patricia
González-Lobato, Ismael
Martínez-Lara, Manuela
Ruiz-Montero, María M
Romero-Morales, Francisco
Vivar Díaz, Itziar
García-Alcántara, Angel
García del Águila, Javier
metadata.dc.contributor.authoraffiliation: [Rosell-Ortiz,F; Fernández-Valle,P; González-Lobato, I; Martínez-Lara,M; Ruiz-Montero,MM; Romero-Morales,F; Vivar Díaz,I; García del Águila,J] 1Empresa Pública de Emergencias Sanitarias de Andalucía. Andalusian Health Ministry, Andalucía, Spain. [Mellado-Vergel,FJ] Department of Urgencias, Hospital el Toyo, Almería, Spain. [García-Alcántara,A] Intensive Care Unit, Hospital Clínico, Málaga, Spain
Keywords: Cardiac care;Acute myocardal infarct;Death/mortality;Emergency ambulance systems;Effectiveness;Prehospital care
metadata.dc.subject.mesh: Medical Subject Headings::Diseases::Cardiovascular Diseases::Heart Diseases::Heart Arrest::Out-of-Hospital Cardiac Arrest
Medical Subject Headings::Diseases::Cardiovascular Diseases::Heart Diseases::Myocardial Ischemia::Myocardial Infarction
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Vital Statistics::Mortality::Fatal Outcome
Medical Subject Headings::Health Care::Health Care Facilities, Manpower, and Services::Health Services::Emergency Medical Services
Medical Subject Headings::Health Care::Health Care Facilities, Manpower, and Services::Health Services::Emergency Medical Services::Transportation of Patients::Ambulances
Medical Subject Headings::Health Care::Health Care Quality, Access, and Evaluation::Quality of Health Care::Health Care Evaluation Mechanisms::Statistics as Topic::Data Interpretation, Statistical
Medical Subject Headings::Check Tags::Female
Medical Subject Headings::Check Tags::Male
Medical Subject Headings::Named Groups::Persons::Occupational Groups::Emergency Responders
Issue Date: 25-Jul-2014
Publisher: BMJ Publishing Group,
Citation: Rosell-Ortiz F, Mellado-Vergel FJ, Fernández-Valle P, González-Lobato I, Martínez-Lara M, Ruiz-Montero MM. Initial complications and factors related to prehospital mortality in acute myocardial infarction with ST segment elevation. Emerg Med J, Online First 25 July 2014.
Abstract: OBJECTIVE Hospital mortality in myocardial infarction ST-elevation myocardial infarction has decreased in recent years, in contrast to prehospital mortality. Our objective was to determine initial complications and factors related to prehospital mortality in patients with acute myocardial infarction with ST segment elevation (STEMI). METHODS Observational study based on a prospective continuous register of patients of any age attended by out-of-hospital emergency teams in Andalusia between January 2006 and June 2009. This includes patients with acute coronary syndrome-like symptoms whose initial ECG showed ST elevation or presumably new left bundle branch block (LBBB). Epidemiological, prehospital data and final diagnostic were recorded. The study included all patients with STEMI on the register, without age restrictions. Forward stepwise logistic regression analysis was performed to control for confounders. RESULTS A total of 2528 patients were included, 24% were women. Mean age 63.4±13.4 years; 16.7% presented atypical clinical symptoms. Initial complications: ventricular fibrillation (VF) 8.4%, severe bradycardia 5.8%, third-degree atrial-ventricular (AV) block 2.4% and hypotension 13.5%. Fifty-two (2.1%) patients died before reaching hospital. Factors associated with prehospital mortality were female sex (OR 2.36, CI 1.28 to 4.33), atypical clinical picture (OR 2.31, CI 1.21 to 4.41), hypotension (OR 4.95, CI 2.60 to 9.20), LBBB (OR 4.29, CI 1.71 to 10.74), extensive infarction (ST elevation in ≥5 leads) (OR 2.53, CI 1.28 to 5.01) and VF (OR 2.82, CI 1.38 to 5.78). CONCLUSIONS A significant proportion of patients with STEMI present early complications in the prehospital setting, and some die before reaching hospital. Prehospital mortality was associated with female sex and atypical presentation, as pre-existing conditions, and hypotension, extensive infarction, LBBB and VF on emergency team attendance.
metadata.dc.identifier.doi: 10.1136/emermed-2014-203780
ISSN: 1472-0213 (Online)
1472-0205 (Print)
Appears in Collections:01- Artículos - APES Hospital de Poniente
01- Artículos - EPES. Empresa Pública de Emergencias Sanitarias
01- Artículos - Hospital Virgen de la Victoria

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