ISSN: 1885-5857 Impact factor 2023 7.2
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Original article
Effectiveness of STEMI networks with out-of-hospital triage: a systematic review and meta-analysis

Efectividad de las redes de atención al IAMCEST de diagnóstico extrahospitalario: revisión sistemática y metanálisis

Joan Cartanya-BonvehiabcAnna Pericas-VilabIsaac SubiranadeCosme García-GarcíadfHelena Tizón-MarcosdegRoberto Elosuabde
https://doi.org/10.1016/j.rec.2024.07.008
La versión en español de este artículo estará disponible en breve

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10.1016/j.rec.2024.07.008
Abstract
Introduction and objectives

Primary percutaneous coronary intervention (pPCI) is recommended for ST elevation myocardial infarction (STEMI). Countries have designed various STEMI network models to optimize out-of-hospital triage, timely treatment, and patient outcomes. The aim of this study was to evaluate the effectiveness of STEMI network implementation including out-of-hospital triage in improving STEMI case-fatality and long-term mortality, and its effect on the proportion of patients presenting with heart failure, their ischemia time, and time to pPCI.

Methods

Systematic review and meta-analysis. Searches of PubMed, Scopus, and Web of Science databases covering January 2000 to December 2023, study selection, and data extraction were completed by 3 independent reviewers.

Results

A total of 32 articles were selected. STEMI network implementation with out-of-hospital triage was associated with reductions of 35% in case-fatality (95%CI, -23% to -45%), 27% in long-term mortality (95%CI, -22% to -32%), and in the proportion of patients with Killip III-IV at admission, ischemia, time and time to pPCI (-17%, 95%CI, -35% +6%; -19%, 95%CI, -6% to -31%; -33%, 95%CI, -16% to -47%, respectively). Networks based on emergency transport systems and those involving the entire health system, including primary care centers and hospitals without pPCI capabilities, showed similar effectiveness. Greater effectiveness was observed in urban vs rural areas and high-income vs middle- and low-income countries.

Conclusions

The implementation of out-of-hospital triage-based STEMI networks is effective in reducing STEMI case-fatality and long-term mortality, independently of the geographic and socioeconomic conditions of the region. Participation of the emergency transport system is the key element of successful networks.

Keywords

Effectiveness
STEMI network
Case-fatality
Mortality

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