Time From First Medical Contact to Aspirin in ST Elevation Myocardial Infarction: An International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC) Study

BACKGROUND: A significant number of patients who suffer from STEMI do not reach a hospital within the recommended timeframe in the South Eastern European countries. Unequal dispersion of PCI-capable facilities throughout this area results in transport distances that can exceed 100 miles, while response times vary greatly dependent upon volunteer ambulance services. METHODS: The aim of the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC /NCT01218776 ) registry was to assess whether initial antiplatelet/ anticoagulant treatment at the point of prehospital first medical contact impacts in-hospital outcomes. To assess the value of this strategy were compared: prehospital versus in-hospital first medical contact; those arriving at the hospital by ambulance versus those whose initial hospital care was an ambulatory/community center. RESULTS: Of the 2295 patients enrolled in the study, 392 received fibrinolysis, 753 primary PCI, 86 facilitated PCI, and 1064 standard medical therapy having overcome the golden hours for reperfusion therapy. Compared with the in-hospital group, patients who underwent facilitated PCI (7%, n=34) experienced 9.6 % reduction in cardiovascular mortality (odd ratio [OR] 0.096 coefficient interval [C.I] 0.012-0.69 P=0.004). Arrival by an ambulatory/community center incurred a substantial delay from first medical contact to reperfusion (fibrinolysis 76 min [63 min to 105 min] and PCI 35 min [224 min to 612 min]) compared with arrival by ambulance (fibrinolysis 47 min [32 min to 68 min] and PCI 108 min [85 min to 150 min]). CONCLUSIONS: These findings support prehospital antiplatelet/ anticoagulant treatment followed by reperfusion therapy in patients presenting early with STEMI, who do not have access to hospital care within the recommended time-frame of 60 minutes from first medical contact. Those activating the prehospital medical response system without receiving prehospital ambulance assignment experienced the longest delay from first medical contact to reperfusion, indicating a lost opportunity to enhance ST elevation myocardial infarction patient outcomes