Background Delay to reperfusion in ST-elevation myocardial infarction (STEMI) is detrimental, but can be minimised with prehospital notification by ambulance to the treating hospital. We aimed to assess whether prenotification was associated with improved first medical contact to balloon times (FMC-BT) and whether this resulted in better clinical outcomes. We also aimed to identify factors associated with use of prenotification. Methods This was a retrospective study of prospective Victorian Cardiac Outcomes Registry data for patients undergoing primary percutaneous coronary intervention for STEMI from 2013-2018. Postcardiac arrest were excluded. Patients were grouped by whether they arrived by ambulance with prenotification (group 1), arrived by ambulance without prenotification (group 2) or self-presented (group 3). We compared groups by FMC-BT, incidence of major adverse cardiac and cerebrovascular events (MACCE), mortality and factors associated with the use of prenotification. Results 2891 patients were in group 1 (79.3% male), 1620 in group 2 (75.7% male) and 1220 in group 3 (82.9% male). Patients who had prenotification were more likely to present in-hours (p=0.004) and self-presenters had lowest rates of cardiogenic shock (p<0.001). Prenotification had shorter FMC-BT than without prenotification (104 min vs 132 min, p<0.001) Self-presenters had superior clinical outcomes, with no difference between ambulance groups. Groups 1 and 2 had similar 30-day MACCE outcomes (7.4% group 1 vs 9.1% group 2, p=0.05) and similar mortality (4.6% group 1 vs 5.9% group 2, p=0.07). In multivariable analysis, male gender, right coronary artery culprit and in-hours presentation independently predicted use of prenotification (all p<0.05). Conclusion Differences in clinical characteristics, particularly gender, time of presentation and culprit vessel may influence ambulance prenotification. Ambulance cohorts have high-risk features and worse outcomes compared with self-presenters. Improving system inequality in prehospital STEMI diagnosis is recommended for fastest STEMI treatment. Data are available on reasonable request. Data may be obtained from a third party and are not publicly available. Data are from the Victorian Cardiac Outcomes Registry (vcor@monash.edu), which gathers de-identified participant data with informed consent and opt-out required.

中文翻译：

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医院预先通知 STEMI 的预测因素以及预先通知与结果的关联

背景 ST 段抬高型心肌梗死 (STEMI) 再灌注延迟是有害的，但可以通过救护车到治疗医院的院前通知将其最小化。我们旨在评估预先通知是否与改善首次医疗接触气球时间 (FMC-BT) 相关，以及这是否会带来更好的临床结果。我们还旨在确定与使用预先通知相关的因素。方法 这是一项回顾性研究，对 2013-2018 年因 STEMI 接受初次经皮冠状动脉介入治疗的患者的前瞻性维多利亚心脏结局登记数据进行研究。排除心脏后骤停。患者按他们是通过预先通知的救护车到达（第 1 组）、在没有预先通知的情况下乘坐救护车到达（第 2 组）还是自行到达（第 3 组）对患者进行分组。我们通过 FMC-BT 比较组，主要不良心脑血管事件 (MACCE) 的发生率、死亡率和与使用预先通知相关的因素。结果第1组2891例（79.3%男性），第2组1620例（75.7%男性）和第3组1220例（82.9%男性）。预先通知的患者更有可能在数小时内就诊（p=0.004），而自行就诊的患者心源性休克发生率最低（p<0.001）。与没有预先通知相比，预先通知的 FMC-BT 更短（104 分钟对 132 分钟，p<0.001） 自我介绍者具有更好的临床结果，救护车组之间没有差异。第 1 组和第 2 组具有相似的 30 天 MACCE 结果（第 1 组 7.4% 对第 2 组 9.1%，p=0.05）和相似死亡率（第 1 组 4.6% 对第 2 组 5.9%，p=0.07）。在多变量分析中，男性、右冠状动脉的罪魁祸首和工时表现独立预测了预先通知的使用（所有 p<0.05）。结论 临床特征的差异，特别是性别、就诊时间和罪犯血管可能会影响救护车的预先通知。与自我介绍者相比，救护车队列具有高风险特征和更差的结果。建议改善院前 STEMI 诊断中的系统不平等，以实现最快的 STEMI 治疗。可根据合理要求提供数据。数据可能从第三方获得，并且不公开。数据来自 Victorian Cardiac Outcomes Registry (vcor@monash.edu)，它在知情同意和选择退出的情况下收集去识别的参与者数据。特别是性别、出现时间和罪犯船只可能会影响救护车的预先通知。与自我介绍者相比，救护车队列具有高风险特征和更差的结果。建议改善院前 STEMI 诊断中的系统不平等，以实现最快的 STEMI 治疗。可根据合理要求提供数据。数据可能从第三方获得，并且不公开。数据来自 Victorian Cardiac Outcomes Registry (vcor@monash.edu)，它在知情同意和选择退出的情况下收集去识别的参与者数据。特别是性别、出现时间和罪犯船只可能会影响救护车的预先通知。与自我介绍者相比，救护车队列具有高风险特征和更差的结果。建议改善院前 STEMI 诊断中的系统不平等，以实现最快的 STEMI 治疗。可根据合理要求提供数据。数据可能从第三方获得，并且不公开。数据来自 Victorian Cardiac Outcomes Registry (vcor@monash.edu)，它在知情同意和选择退出的情况下收集去识别的参与者数据。可根据合理要求提供数据。数据可能从第三方获得，并且不公开。数据来自 Victorian Cardiac Outcomes Registry (vcor@monash.edu)，它在知情同意和选择退出的情况下收集去识别的参与者数据。可根据合理要求提供数据。数据可能从第三方获得，并且不公开。数据来自 Victorian Cardiac Outcomes Registry (vcor@monash.edu)，它在知情同意和选择退出的情况下收集去识别的参与者数据。