Emergency ambulance triggered 'false activation' callout for primary percutaneous coronary intervention is not a benign phenomenon

摘要

Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion strategy following an acute ST-elevation myocardial infarction (STEMI), [1]. The success of the service has been achieved by the contribution of trained paramedic crew [2-4]. Data from the British Cardiovascular Intervention Society audit 2011 showed that 88,692 PCIs were performed in the UK and of those, 24.3% were PPCI (n =21,528), [5].Since 2005, 24/7 PPCI has been the first line treatment for an acute STEMI in our centre. Over 90% represent direct patient admissions by the London Ambulance Service (LAS), but a significant proportion do not fulfil the complete the diagnostic criteria' for STEMI and therefore may not proceed to immediate PPCI. We have termed this patient cohort "false activations".The majority of our PPCI cases are activated by LAS who provide initial patient assessment and ECG interpretation. Ambulance crew directly contact the heart attack centre switchboard, following which a PPCI call is announced and received by the on-call Cardiology team. At the hospital, the patient and ECG are assessed by the awaiting Cardiology team and a decision about immediate coronary angiography is made.