Pre-hospital diagnosis, triage and treatment in patients with ST elevation myocardial infarction

The treatment of acute ST elevation myocardial infarction (STEMI) has greatly improved in the last three decades, especially after the introduction of primary percutaneous coronary intervention (PCI). However, primary PCI is available in selected centres only, thus necessitating transportation of the STEMI patient. Improvement in the logistics of care for these patients is associated with significant improvement of patient outcome. Both the American Heart Association (AHA) and the European Society of Cardiology (ESC) STEMI guidelines recommend pre-hospital infarct diagnosis as a class I recommendation.(w1 w2) Despite this, the large majority of STEMI patients are only diagnosed after arrival in the hospital. 1 Therefore, great care should be taken in the initial diagnosis, risk assessment and triage, subsequent transfer and the distance of transportation as well as pre- and in-hospital time delays in these patients.