Rosell-Ortiz, FernandoMellado-Vergel, Francisco JFernández-Valle, PatriciaGonzález-Lobato, IsmaelMartínez-Lara, ManuelaRuiz-Montero, María MRomero-Morales, FranciscoVivar Díaz, ItziarGarcía-Alcántara, AngelGarcía del Águila, Javier2015-01-262015-01-262014-07-25Rosell-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 2014.1472-0205http://hdl.handle.net/10668/1802JOURNAL ARTICLE;OBJECTIVE Hospital 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). METHODS Observational 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. RESULTS A 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). CONCLUSIONS A 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.spaCardiac careAcute myocardal infarctDeath/mortalityEmergency ambulance systemsEffectivenessPrehospital careMedical Subject Headings::Diseases::Cardiovascular Diseases::Heart Diseases::Heart Arrest::Out-of-Hospital Cardiac ArrestMedical Subject Headings::Diseases::Cardiovascular Diseases::Heart Diseases::Myocardial Ischemia::Myocardial InfarctionMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Vital Statistics::Mortality::Fatal OutcomeMedical Subject Headings::Health Care::Health Care Facilities, Manpower, and Services::Health Services::Emergency Medical ServicesMedical Subject Headings::Health Care::Health Care Facilities, Manpower, and Services::Health Services::Emergency Medical Services::Transportation of Patients::AmbulancesMedical Subject Headings::Health Care::Health Care Quality, Access, and Evaluation::Quality of Health Care::Health Care Evaluation Mechanisms::Statistics as Topic::Data Interpretation, StatisticalMedical Subject Headings::Check Tags::FemaleMedical Subject Headings::Check Tags::MaleMedical Subject Headings::Named Groups::Persons::Occupational Groups::Emergency Respondersresearch article25062682open access10.1136/emermed-2014-2037801472-0213