The “SHAHAL” experience in Israel for improving diagnosis of acute coronary syndromes in the prehospital setting

Roth, Arie; Malov, Nomi; Golovner, Michal; Sander, Judith; Shapira, Itzhak; Kaplinsky, Elieser; Laniado, Shlomo

doi:10.1016/s0002-9149(01)01800-8

Cited by 23 publications

(12 citation statements)

References 19 publications

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“…The results of the (small) study of 53 patients by DiSerio and colleagues with a surprisingly high reported 91% sensitivity, would probably not be replicated in a population of all-comers with chest pain [58]. One study by Roth and colleagues investigated the possibility to rule-out AMI in patients with long symptom duration and atypical chest pain [54]. They used a biomarker panel of creatinine kinase myocardial band (CK-MB), myoglobin and cardiac troponin I (cTnI) with a low analytical sensitivity.…”

Section: Prehospital Biomarker Measurementmentioning

confidence: 99%

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Prehospital diagnosis of patients with acute myocardial infarction

et al. 2016

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Primary percutaneous intervention (PPCI) is the preferred treatment in patients with ST elevation myocardial infarction (STEMI) if this can be performed in a timely manner. The 2012 ESC Guidelines on management of AMI in patients presenting with ST-segment elevation advice that PPCI should be performed within 120 min of first medical contact. Prehospital diagnosis of patients with STEMI is performed to save time and make PPCI available to the majority of patients. Although diagnosing patients with STEMI is usually easy, there are important pitfalls and patients with STEMI are missed on occasion. In addition, it is well know that patients without ST elevation may also have a high-risk cardiac condition. The 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation stress the importance of urgent CAG in patients with high-risk non ST-segment elevation myocardial infarction (NSTEMI). Unfortunately, these patients are difficult to diagnose in the acute phase and important time may be spend establishing the correct diagnosis. Prehospital biomarker measurement has emerged as a method to gain important additional information. We review the evidence on prehospital diagnosis of patients with STEMI and, In addition, we present the current knowledge on the new diagnostic methods that could have a future role in prehospital rule-in and rule-out of cardiac disease.

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Section: Prehospital Biomarker Measurementmentioning

confidence: 99%

“…A total of 10 studies, investigating the utility of POCT of biomarkers in the ambulance, have been performed and are summarized in Table 1 [53][54][55][56][57][58][59][60][61][62]. Many studies include a low number of patients with a high prevalence of AMI which suggests selection.…”

Section: Prehospital Biomarker Measurementmentioning

confidence: 99%

Prehospital diagnosis of patients with acute myocardial infarction

et al. 2016

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“…The medical facility 'SHL', which incorporates telecardiological and face-to-face professional medical assistance to its >60,000 subscribers, was already described in detail elsewhere [4,5]. Briefly, it operates through a monitoring center managed by intensive care nurses who dispatch mobile intensive care units staffed by physicians and paramedics to subscribers.…”

Section: The Systemmentioning

confidence: 99%

Telecardiology for patients with chronic heart failure: the ‘SHL’ experience in Israel

Roth

Kajiloti²,

Elkayam³

et al. 2004

International Journal of Cardiology

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“…In the third study, 777 consecutive patients with acute chest pain (not typical for myocardial ischemia) were evaluated in the pre-hospital phase, where the symptoms had lasted for six to 48 h (12). In this analysis, CK-MB, myoglobin and troponin I were evaluated.…”

Section: Impact On Diagnosismentioning

confidence: 99%

The value of biochemical markers for risk stratification prior to hospital admission in acute chest pain

Herlitz

Svensson

2008

Acute Cardiac Care

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We describe the use of biochemical markers in the pre-hospital setting with regard to diagnostic accuracy for the detection of an acute myocardial infarction (AMI) and for prognosis in connection with acute chest pain. The sensitivity has been reported to be limited; blood sampling occurs very early and often prior to the release of biochemical markers into the circulation. The specificity was in some studies also limited, but this is more difficult to explain. New biochemical markers like human heart fatty acid binding protein (H-FACB) have shown improved diagnostic accuracy, in the pre-hospital setting, in one small pilot study compared with traditional biochemical markers like troponins, creatine kinase (CK-MB) and myoglobin. However, in a recent small study, the sensitivity for troponin I (when a low decision limit for myocardial damage was used), when analysed prior to hospital admission, was reported to be very high. The latter data need to be confirmed in larger studies and various biochemical markers reflecting various pathophysiological aspects of the disease need to be tested before the analysis of any marker can be recommended for use in the pre-hospital setting of a suspected AMI.

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The “SHAHAL” experience in Israel for improving diagnosis of acute coronary syndromes in the prehospital setting

Cited by 23 publications

References 19 publications

Prehospital diagnosis of patients with acute myocardial infarction

Prehospital diagnosis of patients with acute myocardial infarction

Telecardiology for patients with chronic heart failure: the ‘SHL’ experience in Israel

The value of biochemical markers for risk stratification prior to hospital admission in acute chest pain

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