M.D., Research fellow, Rigshospitalet, University of CopenhagenGraduated in January 2007 and completed 1 ½ year internship and 1 ½ year residency in internal medicine and cardiology before entering a 3 year PhD program at the Department of Cardiology, Rigshospitalet, University of Copenhagen, which has let to a post doc. program offer at Mount Sinai Heart, New York.
Reperfusion delay in patients treated with primary percutaneous coronary intervention: Insight from a real world Danish STEMI population in the era of telemedicine
The efficiency of STEMI networks to ensure primary PCI to as many patients as possible has been a landmark achievement in acute cardiac care. I was curious to investigate how these networks can be further refined and how we close the organizational gaps for patients that still suffer large myocardial infarctions.
Reperfusion delay in ST-segment elevation myocardial infarction predicts myocardial infarct size, subsequent heart failure and mortality. The implementation of telemedicine by pre-hospital 12-lead ECG recording and transmission to an attending cardiologist in a PCI-capable center reduces time from alarm call (system delay) by short passing local hospitals. However, marked system delay may still be the reality for patients redirected for primary PCI by telemedicine. In 472 STEMI patients, we evaluated system delay and time from first medical contact, where fibrinolysis in theory could be initiated, to balloon inflation in a pre-hospital organization with tele-transmitted electrocardiograms, field triage and direct transfer to a 24/7 primary PCI center.We found that pre-hospital triage is feasible in 75 % and transfer over distances up to ≈ 200 km is safe, even by-passing local hospitals en route to pPCI. Patients being non-directly referred were delayed by 100 min beyond ESC guidelines. Improved patient awareness towards calling 112 for chest pain and ECG education for emergency medical services personnel could raise the figure of patients directly transferred to a primary PCI center to 90 %, resulting in more STEMI patients being treated in time to improve survival, as this study also confirmed that system delay predicts mortality. Even when well functioning pre-hospital triage is in place, only 20 % of patients living >100 km away from a pPCI capable center were treated within ESC guidelines, stressing the need for adaptive STEMI networks with better EMS education, helicopter transfer or pharmaco-invasive regiments in selected patients. Ongoing research on improved algorithms for ischemia detection by ECG or detection of myocardial injury using biomarkers could potentially further improve early diagnosis and thereby pre-hospital triage.
This nomination has already brought me some attention at my institution and in my home country, as the results are now addressed in working groups of our national society. It gave me the opportunity to meet with peers who share interests and ideas, and to learn from the presentation experience and the judges scrutinizing my work during the YIA abstract session. This nomination has also given me a great motivation burst to further pursue my research career.
My research has evolved around acute coronary syndromes diagnostics and risk stratification in the pre-hospital and early in-hospital phase, the time window wherein also the greatest unresolved survival challenges lie in ACS. To handle this challenge is one of the declared goals of ACCA. Being an ACCA member is therefore a natural consequence of my research interests, and ACCA helps me in general terms with providing a highly relevant journal, publication and communication platforms. Specifically ACCA has helped me with press releases of my research. In the future, I hope that I through ACCA can further connect with international peers and learn from opinion leaders within the field of acute cardiac care.
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