Effectiveness of STEMI networks with out-of-hospital triage: a systematic review and meta-analysis

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• dc.contributor.author Cartanya-Bonvehi, Joan
• dc.contributor.author Pericas-Vila, Anna
• dc.contributor.author Subirana Cachinero, Isaac
• dc.contributor.author García-García, Cosme
• dc.contributor.author Tizón-Marcos, Helena
• dc.contributor.author Elosua Llanos, Roberto
• dc.date.accessioned 2025-07-29T14:38:56Z
• dc.date.embargoEnd info:eu-repo/date/embargoEnd/2026-04-01
• dc.date.issued 2025
• dc.description.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.
• dc.embargo.liftdate 2026-04-01
• dc.format.mimetype application/pdf
• dc.identifier.citation Cartanya-Bonvehi J, Pericas-Vila A, Subirana I, García-García C, Tizón-Marcos H, Elosua R. Effectiveness of STEMI networks with out-of-hospital triage: a systematic review and meta-analysis. Rev Esp Cardiol (Engl Ed). 2025 Apr;78(4):311-8. DOI: 10.1016/j.rec.2024.07.008
• dc.identifier.doi http://dx.doi.org/10.1016/j.rec.2024.07.008
• dc.identifier.issn 1885-5857
• dc.identifier.uri http://hdl.handle.net/10230/71028
• dc.language.iso eng
• dc.publisher Elsevier
• dc.relation.ispartof Rev Esp Cardiol (Engl Ed). 2025 Apr;78(4):311-8
• dc.rights © Elsevier http://dx.doi.org/10.1016/j.rec.2024.07.008
• dc.rights.accessRights info:eu-repo/semantics/embargoedAccess
• dc.subject.keyword Effectiveness
• dc.subject.keyword STEMI network
• dc.subject.keyword Case-fatality
• dc.subject.keyword Mortality
• dc.title Effectiveness of STEMI networks with out-of-hospital triage: a systematic review and meta-analysis
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/acceptedVersion