Impact of mobile intensive care unit use on total ischemic time and clinical outcomes in ST-elevation myocardial infarction patients - real-world data from the Acute Coronary Syndrome Israeli Survey.
BACKGROUND
Ischemic time has prognostic importance in ST-elevation myocardial infarction patients. Mobile intensive care unit use can reduce components of total ischemic time by appropriate triage of ST-elevation myocardial infarction patients.


METHODS
Data from the Acute Coronary Survey in Israel registry 2000-2010 were analyzed to evaluate factors associated with mobile intensive care unit use and its impact on total ischemic time and patient outcomes.


RESULTS
The study comprised 5474 ST-elevation myocardial infarction patients enrolled in the Acute Coronary Survey in Israel registry, of whom 46% ( n=2538) arrived via mobile intensive care units. There was a significant increase in rates of mobile intensive care unit utilization from 36% in 2000 to over 50% in 2010 ( p<0.001). Independent predictors of mobile intensive care unit use were Killip>1 (odds ratio=1.32, p<0.001), the presence of cardiac arrest (odds ratio=1.44, p=0.02), and a systolic blood pressure <100 mm Hg (odds ratio=2.01, p<0.001) at presentation. Patients arriving via mobile intensive care units benefitted from increased rates of primary reperfusion therapy (odds ratio=1.58, p<0.001). Among ST-elevation myocardial infarction patients undergoing primary reperfusion, those arriving by mobile intensive care unit benefitted from shorter median total ischemic time compared with non-mobile intensive care unit patients (175 (interquartile range 120-262) vs 195 (interquartile range 130-333) min, respectively ( p<0.001)). Upon a multivariate analysis, mobile intensive care unit use was the most important predictor in achieving door-to-balloon time <90 min (odds ratio=2.56, p<0.001) and door-to-needle time <30 min (odds ratio=2.96, p<0.001). One-year mortality rates were 10.7% in both groups (log-rank p-value=0.98), however inverse propensity weight model, adjusted for significant differences between both groups, revealed a significant reduction in one-year mortality in favor of the mobile intensive care unit group (odds ratio=0.79, 95% confidence interval (0.66-0.94), p=0.01).


CONCLUSIONS
Among patients with ST-elevation myocardial infarction, the utilization of mobile intensive care units is associated with increased rates of primary reperfusion, a reduction in the time interval to reperfusion, and a reduction in one-year adjusted mortality.
['Koifman|Edward|E|', 'Beigel|Roy|R|', 'Iakobishvili|Zaza|Z|', 'Shlomo|Nir|N|', 'Biton|Yitschak|Y|', 'Sabbag|Avi|A|', 'Asher|Elad|E|', 'Atar|Shaul|S|', 'Gottlieb|Shmuel|S|', 'Alcalai|Ronny|R|', 'Zahger|Doron|D|', 'Segev|Amit|A|', 'Goldenberg|Ilan|I|', 'Strugo|Rafael|R|', 'Matetzky|Shlomi|S|']
D054058:Acute Coronary Syndrome D000552:Ambulances D017023:Coronary Angiography D004562:Electrocardiography D005260:Female D005500:Follow-Up Studies D017052:Hospital Mortality D006801:Humans D007557:Israel D008297:Male D008875:Middle Aged D016017:Odds Ratio D012042:Registries D012189:Retrospective Studies D000072657:ST Elevation Myocardial Infarction D011795:Surveys and Questionnaires D015996:Survival Rate D061665:Time-to-Treatment
Mobile intensive care primary reperfusion ST elevation myocardial infarction prognosis