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Original Articles

Implementation of Guidelines for the Treatment of Acute ST-Elevation Myocardial Infarction

The Cologne Infarction Model Registry

Markus Flesch, MD, MSc; Jens Hagemeister, MD; Hans-Joerg Berger, MD; Annett Schiefer; Sylke Schynkowski; Martin Klein; Sassan Sahebdjami; Stephan vom Dahl, MD; Wolfgang Fehske, MD; Rudolf Mies, MD; Michael von Eiff, MD; Holger Pfaff, MD; Peter Frommolt, MSc and Hans-Wilhelm Hoepp, MD

From the Klinik III für Innere Medizin (M.F., J.H., S.S., M.K., H.-W.H.) and Krankenhaus Merheim, Lehrstuhl II für Innere Medizin (H.-J.B.), Universitaet zu Koeln, Cologne, Germany; St. Franziskus-Hospital, Cologne, Germany (A.S., S.S., S.v.D.); St. Vinzenz-Hospital, Cologne, Germany (W.F.); St. Antonius-Krankenhaus, Cologne, Germany (R.M.); Malteser-Krankenhaus St. Hildegardis, Cologne, Germany (M.v.E.); Zentrum für Versorgungsforschung der Universitaet zu Koeln, Cologne, Germany (H.P.); Institut für Medizinische Statistik, Informatik und Epidemiologie der Universitaet zu Koeln, Cologne, Germany (P.F.).

Correspondence to Markus Flesch, MD, MSc, Klinik III für Innere Medizin der Universitaet zu Koeln, Kerpener Strasse 62, 50937 Cologne, Germany. E-mail markus.flesch{at}uni-koeln.de

Received January 23, 2008; accepted August 15, 2008.

Background— The aim of the Köln (Cologne) Infarction Model is to examine the feasibility of obligatory treatment of ST-segment–elevation myocardial infarction (STEMI) by first-line percutaneous coronary intervention.

Methods and Results— The study was performed in Cologne with >1 million citizens, 5 coronary intervention centers, and 11 primary care hospitals. Twelve-lead ECG was available for all emergency medical service (EMS) teams. Partners guaranteed direct transfer of STEMI patients to a catheterization laboratory. A total of 519 patients treated within KIM in 2006 were included in the study. Of these, 24% presented at a primary care hospital, 11% presented directly at a coronary intervention center, 5% were transferred by EMS to primary care hospitals, and 60% were directly transferred by EMS to a catheterization laboratory. In 91% of cases, the catheterization laboratory was notified of the patient’s arrival in advance. False-positive ECG diagnosis of STEMI by EMS accounted for 6%. Median treatment times were as follows: from the start of symptoms to first medical contact, 120 minutes; phone to balloon, 70 minutes; and door to balloon, 49 minutes. Of all patients, 93% underwent angiography; 409 patients were treated by coronary intervention, and 24 underwent emergency coronary artery bypass graft. Thrombolysis in Myocardial Infarction grade 3 flow was obtained in 89%. In the hospitals, deaths and new myocardial infarctions were observed in 12.1% and in 1.9% of all patients, respectively.

Conclusion— The Cologne Infarction Model provides evidence for the feasibility of obligatory treatment of STEMI by primary coronary intervention in a metropolitan setting. Acceptance of treatment pathways allowed nearly all STEMI patients to undergo coronary angiography. ECG competence of EMS was excellent. Treatment times were within postulated limits. Results, including mortality, were within a high quality range.

Key Words: angioplasty • catheterization • emergency service • guideline • myocardial infarction

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CLINICAL PERSPECTIVE

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Implementation of Guidelines for the Treatment of Acute ST-Elevation Myocardial Infarction: The Cologne Infarction Model Registry

Markus Flesch, Jens Hagemeister, Hans-Joerg Berger, Annett Schiefer, Sylke Schynkowski, Martin Klein, Sassan Sahebdjami, Stephan vom Dahl, Wolfgang Fehske, Rudolf Mies, Michael von Eiff, Holger Pfaff, Peter Frommolt, and Hans-Wilhelm Hoepp
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