Mortality and ST resolution in patients admitted with STEMI: the MOMI survey of emergency service experience in a complex urban area

Abstract

Background: Since 2001, the urban area of Milan has been operating a network among 23 cardiac care units, the 118 dispatch centre (national free number for medical emergencies), and the county government health agency called Group for Prehospital Cardiac Emergency. Methods and results:In order to monitor the network activity, time to treatment, and clinical outcome, a periodic survey, called MOMI 2 , was repeated two or three times a year. Each survey lasted 30 days and was repeated in comparable periods. Data were stratified for hospital admission mode. We collected data concerning 708 consecutive ST-elevation myocardial infarction (STEMI) patients (male 72.6%; mean age 64.4 years). In these six surveys, we observed a high rate of primary percutaneous coronary intervention (73.2%) and a mortality rate of 6.3%. Using advanced statistical models, we identified age, Killip class, and the symptom onset-to-balloon time as most relevant prognostic factors. Nonparametric test showed that the modality of hospital admittance was the most critical determinant of door-to-balloon time. 12-lead ECG tele-transmission and activation of a fast track directly to the catheterization laboratory are easy action to reduce time to treatment. Conclusions: The experience of the Milan network for cardiac emergency shows how a network coordinating the community, rescue units, and hospitals in a complex urban area and making use of medical technology contributes to the health care of patients with STEMI.

The Effectiveness of Using Ecg Teletransmission During Emergency Medical Team Interventions

“…The results obtained confirmed the high effectiveness in diagnosing ST-ACS by members of emergency medical response teams. Grieko et al [8], in research on the emergency medical response system in Italy, demonstrated the influence of ECG teletransmission on shortening the time between the first chest pains and the start of treatment. Tekerlsen et al [9], in their study on the Danish emergency medical system, where ambulance teams use ECG teletransmission, demonstrated a shortening of delays in the start of ST-ACS myocardial infarction treatment due to fast diagnosis and transport of patients directly to cardiology surgery wards.…”

Risk prediction for myocardial infarction via generalized functional regression models

“…4,5 Starting from 2006, in the Milan urban area a working group collecting 23 Cardiology Units and the 118 Dispatch Center (the Italian free-toll number for emergencies), performed monthly data collections twice a year on all patients admitted to any hospital in Milano with coronary artery disease (MOMI 2 : MOnth MOnitoring Myocardial Infarction in MIlan survey). The statistical analysis of the collected data [6][7][8] confirmed the time of first ECG teletransmission as the most important factor to guarantee a quick access to an effective treatment for patients. Since 2008, a project named PROMETEO (PROgetto sull'area Milanese Elettrocardiogrammi Teletrasferiti dall'Extra Ospedaliero) has been started with the aim of spreading the intensive use of ECG as pre-hospital diagnostic tool.…”