RT Journal Article
T1 Initial complications and factors related to prehospital mortality in acute myocardial infarction with ST segment elevation.
A1 Rosell-Ortiz, Fernando
A1 Mellado-Vergel, Francisco J
A1 Fernández-Valle, Patricia
A1 González-Lobato, Ismael
A1 Martínez-Lara, Manuela
A1 Ruiz-Montero, María M
A1 Romero-Morales, Francisco
A1 Vivar Díaz, Itziar
A1 García-Alcántara, Angel
A1 García del Águila, Javier
K1 Cardiac care
K1 Acute myocardal infarct
K1 Death/mortality
K1 Emergency ambulance systems
K1 Effectiveness
K1 Prehospital care
AB OBJECTIVEHospital mortality in myocardial infarction ST-elevation myocardial infarction has decreased in recent years, in contrast to prehospital mortality. Our objective was to determine initial complications and factors related to prehospital mortality in patients with acute myocardial infarction with ST segment elevation (STEMI).METHODSObservational study based on a prospective continuous register of patients of any age attended by out-of-hospital emergency teams in Andalusia between January 2006 and June 2009. This includes patients with acute coronary syndrome-like symptoms whose initial ECG showed ST elevation or presumably new left bundle branch block (LBBB). Epidemiological, prehospital data and final diagnostic were recorded. The study included all patients with STEMI on the register, without age restrictions. Forward stepwise logistic regression analysis was performed to control for confounders.RESULTSA total of 2528 patients were included, 24% were women. Mean age 63.4±13.4 years; 16.7% presented atypical clinical symptoms. Initial complications: ventricular fibrillation (VF) 8.4%, severe bradycardia 5.8%, third-degree atrial-ventricular (AV) block 2.4% and hypotension 13.5%. Fifty-two (2.1%) patients died before reaching hospital. Factors associated with prehospital mortality were female sex (OR 2.36, CI 1.28 to 4.33), atypical clinical picture (OR 2.31, CI 1.21 to 4.41), hypotension (OR 4.95, CI 2.60 to 9.20), LBBB (OR 4.29, CI 1.71 to 10.74), extensive infarction (ST elevation in ≥5 leads) (OR 2.53, CI 1.28 to 5.01) and VF (OR 2.82, CI 1.38 to 5.78).CONCLUSIONSA significant proportion of patients with STEMI present early complications in the prehospital setting, and some die before reaching hospital. Prehospital mortality was associated with female sex and atypical presentation, as pre-existing conditions, and hypotension, extensive infarction, LBBB and VF on emergency team attendance.
PB BMJ Publishing Group,
SN 1472-0205
YR 2014
FD 2014-07-25
LK http://hdl.handle.net/10668/1802
UL http://hdl.handle.net/10668/1802
LA spa
NO Rosell-Ortiz F, Mellado-Vergel FJ, Fernández-Valle P, González-Lobato I, Martínez-Lara M, Ruiz-Montero MM.  Initial complications and factors related to prehospital mortality in acute myocardial infarction with ST segment elevation.  Emerg Med J, Online First 25 July 2014.
NO JOURNAL ARTICLE;
DS RISalud
RD Apr 10, 2025