Trends in clinical outcomes and survival following prehospital thrombolytic therapy given by ambulance clinicians for ST-elevation myocardial infarction in rural sub-arctic Norway

Mannsverk, Jan; Steigen, Terje K.; Wang, Harald; Tande, Pål M.; Dahle, Birgitte Mannsverk; Nedrejord, Maret Lajla; Hokland, Ida Olsen; Gilbert, Mads

doi:10.1177/2048872617748550

Cited by 11 publications

(5 citation statements)

References 23 publications

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“…In this issue the clinical outcomes are reported of STEMI patients living in rural sub-arctic Norway who were treated by prehospital thrombolytic therapy administered by ambulance personnel after 12 lead ECG recording, telemetric transmission and centralized interpretation and decision making by physicians on call in the hospital emergency medical dispatch center. 1 The study confirms the clinical efficacy and safety of prehospital thrombolysis in rural settings with long evacuation lines to primary PCI.…”

supporting

confidence: 67%

Focus on ST elevation myocardial infarction

2019

European Heart Journal: Acute Cardiovascular Care

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supporting

confidence: 67%

Focus on ST elevation myocardial infarction

2019

European Heart Journal: Acute Cardiovascular Care

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“…The development of heart failure after acute coronary syndromes (ACS) is the most common complication associated with a high mortality rate 1,2. Circulating levels of C-reactive protein (CRP) have been shown to be linked to poor prognosis in patients with atherothrombotic problems, heart failure, arrhythmias, and myocarditis.3 Fourteen predictors of heart failure were studied by Ho et al4,5 Important predictors identified were older age, diabetes mellitus, valvular disease, hypertension, higher heart rate, left ventricular hypertrophy, left bundle branch block, cardiovascular disease, body mass index, smoking, gender, and dyslipidemia 4,5.…”

Section: Introductionmentioning

confidence: 99%

<p>Predictive value of high sensitivity C-reactive protein on progression to heart failure occurring after the first myocardial infarction</p>

Aseri

Habib

Marzouk

2019

VHRM

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Background: High sensitivity C-reactive protein (hsCRP) predicts myocardial dysfunction after acute coronary syndromes. We aimed to study the association of hsCRP estimation at first acute myocardial infarction (AMI) with myocardial dysfunction and heart failure. Methods: This research was carried out at the Department of Physiology and Department of Emergency Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. In this prospective study, 227 patients were studied. hsCRP levels were estimated when patients came to the emergency department at AMI, 7 days post AMI, and at 12 weeks of follow up after AMI. The outcome was change in myocardial functions, especially heart failure, 12 months after the attack. Results: Based on a cutoff mean value of hsCRP levels at admission (10.05±12.68 mg/L), patients were grouped into high and low C-reactive protein (CRP.) The ejection fraction was significantly lower at follow up in the high CRP group (37.29±12.97) compared to the low CRP group (43.85±11.77, p <0.0198). hsCRP had significant inverse correlation with left ventricular ejection fraction (r=−0.283, p <0.01). About 38.1% patients showed heart failure, with 23.6% in the high CRP group and 14.5% in the low CRP group (OR 2.4, p =0.028). Receiver operating characteristic curve analysis showed that CRP levels at AMI had a specificity of 79% and sensitivity of 83% to predict heart failure. Conclusion: A high hsCRP level measured at first AMI predicts myocardial dysfunction and heart failure. It is suggested that hsCRP plays an important role in the development of heart failure after myocardial infarction.

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“…31 Pharmacoinvasive treatment may prevent 30 early deaths per 1000 STEMI patients treated within 6 hours after symptom onset, with largest absolute benefit among high-risk patients, including elderly patients. 4 Despite being feasible for about 75% of the patients, the use of prehospital fibrinolysis in the most rural areas of northern Norway was Open access reduced from about 40% to 30% from 2006 to 2011 32 and was used for only 33% of the patients in 2020-2021. 15…”

Section: Open Accessmentioning

confidence: 99%

Exploring variation in timely reperfusion treatment in ST-segment elevation myocardial infarction in Norway: a national register-based cohort study

Uleberg,

Bønaa,

Govatsmark

et al. 2024

BMJ Open

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ObjectivesThis study aimed to investigate determinants of reperfusion within recommended time limits (timely reperfusion) for ST-segment elevation myocardial infarction patients, exploring the impact of geography, patient characteristics and socio-economy.DesignNational register-based cohort study.SettingMultilevel logistic regression models were applied to examine the associations between timely reperfusion and residency in hospital referral areas and municipalities, patient characteristics, and socio-economy.Participants7607 Norwegian ST-segment elevation myocardial infarction patients registered in the Norwegian Registry of Myocardial Infarction during 2015–2018.Main outcome measuresThe odds of timely reperfusion by primary percutaneous coronary intervention (PCI) or fibrinolysis.ResultsAmong 7607 ST-segment elevation myocardial infarction patients in Norway, 56% received timely reperfusion. The Norwegian goal is 85%. While 81% of the patients living in the Oslo hospital referral area received timely reperfusion, only 13% of the patients living in Finnmark did so.Patients aged 75–84 years had lower odds of timely reperfusion than patients below 55 years of age (OR 0.73, 95% CI 0.61 to 0.87). Patients with moderate or high comorbidity had lower odds than patients without (OR 0.81, 95% CI 0.68 to 0.95 and OR 0.61, 95% CI 0.44 to 0.84). More than 2 hours from symptom onset to first medical contact gave lower odds than less than 30 min (OR 0.63, 95% CI 0.54 to 0.72). 1–2 hours of travel time to a PCI centre (OR 0.39, 95% CI 0.31 to 0.49) and more than 2 hours (OR 0.22, 95% CI 0.16 to 0.30) gave substantially lower odds than less than 1 hour of travel time.ConclusionsThe varying proportion of patients receiving timely reperfusion across hospital referral areas implies inequity in fundamental healthcare services, not compatible with established Norwegian health policy. The importance of travel time to PCI centre points at the expanded use of prehospital pharmacoinvasive strategy to obtain the goals of timely reperfusion in Norway.

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Trends in clinical outcomes and survival following prehospital thrombolytic therapy given by ambulance clinicians for ST-elevation myocardial infarction in rural sub-arctic Norway

Cited by 11 publications

References 23 publications

Focus on ST elevation myocardial infarction

Focus on ST elevation myocardial infarction

<p>Predictive value of high sensitivity C-reactive protein on progression to heart failure occurring after the first myocardial infarction</p>

Exploring variation in timely reperfusion treatment in ST-segment elevation myocardial infarction in Norway: a national register-based cohort study

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