Læknablaðið - 01.01.2016, Qupperneq 17
LÆKNAblaðið 2016/102 17
R A N N S Ó K N
ENGLISH SUMMARY
Introduction: ST-segment Elevation Myocardial Infarction (STEMI) is a
life-threatening disease and good outcome depends on early restoration
of coronary blood flow. Primary percutaneous coronary intervention
(PPCI) is the treatment of choice if performed within 120 minutes of
first medical contact (FMC) but in case of anticipated long transport or
delays, pre-hospital fibrinolysis is indicated. The aim was to study tran-
sport times and adherence to clinical guidelines in patients with STEMI
transported from outside of the Reykjavik area to Landspitali University
Hospital in Iceland.
Materials and methods: Retrospective chart review was conducted
of all patients diagnosed with STEMI outside of the Reykjavik area and
transported to Landspitali University Hospital in Reykjavik in 2011-2012.
Descriptive statistical analysis and hypothesis testing was applied.
Results: Eighty-six patients had signs of STEMI on electrocardiogram
(ECG) at FMC. In southern Iceland nine patients (21%) underwent
PPCI within 120 minutes (median 157 minutes) and no patient received
fibrinolysis. In northern Iceland and The Vestman Islands, where long
transport times are expected, 96% of patients eligible for fibrinolysis
(n=31) received appropriate therapy in a median time of 57 minutes.
Significantly fewer patients received appropriate anticoagulation treat-
ment with clopidogrel and enoxaparin in southern Iceland compared to
the northern part. Mortality rate was 7% and median length of stay in
hospital was 6 days.
Conclusions: Time from FMC to PPCI is longer than 120 minutes in
the majority of cases. Pre-hospital fibrinolysis should be considered as
first line treatment in all parts of Iceland outside of the Reykjavik area.
Directly electronically transmitted ECGs and contact with cardiologist
could hasten diagnosis and decrease risk of unnecessary interhospital
transfer. A STEMI database should be established in Iceland to facilitate
quality control.
Transport and treatment of patients with STEMI in rural Iceland – Only a few patients receive PPCI within
120 minutes
Sigmundsson TS1, Arnarson D2, Rafnsson A3, Magnusson V, Gunnarsson GT2,5, Thorgeirsson G4
1Department of Anaesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital, Sweden, 2Faculty of Medicine University of Iceland, 3Dept. of anaesthe-
tics and intensive care | Landspitalinn University Hospital Reykjavik, 4Dept. of Cardiology, 5Akureyri Hospital, Iceland.
Key words: STEMI, fibrinolysis, quality of care, medical transport, rural medicine.
Correspondence: Þórir Sigmundsson, thorir.sigmundsson@karolinska.se
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