Implementation of guidelines for the treatment of acute ST-elevation myocardial infarction: the Cologne Infarction Model Registry.

Background —Aim of the Cologne Infarction Model (KIM) is to examine the feasibility of obligatory treatment of STEMI by first line percutaneous coronary intervention. Methods and Results —The study was performed in Cologne with >1 million citizens, 5 coronary intervention centres and 11 primary care hospitals. 12-lead ECG is available for all EMS teams. Partners guaranteed direct transfer of STEMI patients to a catheterization laboratory. In 2006, 519 patients were included. 24% presented at a primary care hospital, 11% directly at a coronary intervention centre, 5% were transferred by EMS to primary care hospitals, 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: begin of symptoms to first medical contact 120 minutes, phone-to-balloon 70 minutes, and door-to-balloon 49 minutes. 93% of all patients underwent angiography. 409 patients were treated by coronary intervention, 24 underwent emergency CABG. TIMI 3 flow was obtained in 89%. In hospital, deaths and new myocardial infarctions were observed in 12.1 % and in 1.9 % of all patients, respectively. Conclusion —KIM 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.