World's first: Danish paramedics have been trained to take the new blood test in the ambulance 

Introduction of a new blood test in the ambulance will detect more patients with suspected acute myocardial infarction. This is the first sensational result of a new Danish research project. The results are presented today at one of the largest heart congresses in Paris.

As the first in the world, Danish paramedics servicing the specialised heart centres at Aarhus University Hospital and Aalborg University Hospital have been trained to analyse blood samples using an advanced hand-operated instrument in the ambulance.

The blood samples in combination with the electrocardiogram (ECG) improves detection of patients with suspected myocardial infarction and thus at increased risk of acute deterioration of the heart function.

Denmark has the lead in diagnostics and treatment of patients with myocardial infarction. Already in the ambulance, the ECG is recorded and transmitted to the cardiac centre. Here the results are analysed and a cardiac specialist calls the ambulance immediately. If the ECG shows signs of myocardial infarction, the patient is transported directly to one of Denmark’s four heart centres. Immediately upon arrival the coronary artery is examined and often followed by an acute angioplasty procedure.

In half of the patients, the ECG examination does not  detect the myocardial infarction. Today, these patients are transported to the local hospital to undergo diagnostic examination; if there are signs of myocardial infarction an examination of the coronary artery is made within 24 to 72 hours. The newly-developed Danish method ensures that the majority of the most severely ill patients can be diagnosed already in the ambulance. In this way the patient can be admitted directly to the department offering the optimal treatment.

In nine of ten cases the method has been able to detect an acute or sub-acute myocardial infarction with occlusion of the coronary arteries. Of these, 75% of the patients needed angioplasty with insertion of stents or a bypass operation.

- The method with ECG and blood sampling is very precise and it detects the majority of patients in acute need of coronary intervention, says Carsten Stengaard, MD and PhD from Department of Cardiology at Aarhus University Hospital.

He is one of the project leaders in a 4-year project to clarify if patients with an ECG and a blood sample indicating myocardial infarction will benefit from an acute examination of the coronary arteries.

The results from AarhusUniversityHospital and AarhusUniversity are presented May 20 at one of the world’s largest heart congresses, the EuorPCR in Paris.

Approximately 400 patients have so far participated in the project and the results from the first 250 patients are available now. When the results of the ECG and blood samples indicate myocardial infarction, the patients have been randomly assigned to be transported directly to a heart centre or to admission at a local hospital.

The project shows that many patients can benefit considerably or may even have a life-saving effect of getting the right diagnosis.

Patients with myocardial infarction transported directly to a heart centre had a 15% shorter hospital stay on average compared with patients admitted to a local hospital; this is equivalent to almost one whole day of hospital admission.

Among the patients admitted to a local hospital, approximately 15% experienced a deterioration of symptoms and had to be acutely transferred to one of the four heart centres.

- It is yet too early to determine if there is a total treatment benefit by transporting patients directly to an examination of the coronary arteries. But it appears so and we hope to be able to document this when all the results are available, says Carsten Stengaard.

BACKGROUND:
This project studying the effect of ECG in combination with blood sampling and acute examination of the coronary artery in patients with suspected myocardial infarction is conducted in a fruitful collaboration between cardiologists at the heart centres and the regional hospitals, the paramedics in Falck Danmark, Response A/S and Samsø Redningskorps, the Central Denmark Region prehospital and the prehospital in North Denmark Region as well as the producer of the blood sampling equipment, Roche Diagnostics Denmark A/S. The project is completed by cardiologists at Aarhus University Hospital and is supported by funding from the Danish Heart Association, Trygfonden, Lundbeckfonden, Laerdal Fonden, Karl G Andersen Fonden, internal research fund (Spydspidspuljen) at  Aarhus Universitetshospital and The Medicines Company.

EuroPCR is one of the world’s largest heart congresses focusing on state-of-the-art research in advanced (interventional) treatment of cardiac diseases. The congress has approximately 12,000 participants from all over the world and is organised annually by ”The European Association for percutaneous cardivascular interventions” (EAPCI ). This year the congress is held from 19 to 22 May in Paris  http://www.europcr.com/

Project steering committee consists of

• Christian Juhl Terkelsen, Consultant, DMSc, Clinical Associate Professor, Overall project responsible

• Carsten Stengaard, MD, PdH, Project coordinator

• Jacob Thorsted Sørensen, MD, PhD, Project coordinator

• Martin Bøhme Rasmussen, MD, PhD-student, Project coordinator

• Hans Erik Bøtker, Professor, Consultant, DMSc, Project coordinator

Contacts
• Carsten Stengaard, MD, PhD, Department of Cardiology, AarhusUniversityHospital and Department of Clinical Medicine, AarhusUniversity

Mobile phone: +45 2874 1998, e-mail: carsten.stengaard@clin.au.dk

• Christian Juhl Terkelsen, Consultant, DMSc, Clinical Associate Professor, , Department of Cardiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University

Mobile phone: +45 2428 8571, e-mail: christian.terkelsen@skejby.rm.dk