open access

Vol 13, No 3 (2018)
Original Papers
Published online: 2018-07-15
Get Citation

The analysis of standard pharmacotherapy by emergency medical services (the so-called MONA scheme) in myocardial infarction with ST-segment elevation

Grzegorz Wójcik, Zdzisława Kornacewicz-Jach, Maciej Lewandowski, Dawid Surowicz, Natalia Bobak, Krzysztof Zdziarski, Marek Myślak
DOI: 10.5603/FC.2018.0040
·
Folia Cardiologica 2018;13(3):199-203.

open access

Vol 13, No 3 (2018)
Original Papers
Published online: 2018-07-15

Abstract

Introduction. Myocardial infarction is a directly life-threatening condition, which is the most frequent consequence of diseases and deaths in highly developed countries. In Poland there are almost hundred thousand of myocardial infarction cases each year and the morbidity increases. The issue of a huge number of myocardial infarctions is meaningful in many countries all over the world. About 30% of all the myocardial infarctions are the ones with ST-segment elevation (ACS STEMI). The purpose of this paper is to analyse how the pre-hospital care has used a standard pharmacological treatment (the so-called MONA scheme) in the area of Szczecin. This medical care was performed by Emergency Medical Service in case of patients who have ACS STEMI, were hospitalised in Pomeranian Medical University’s (PMU’s) Department of Cardiology, survived this period and were discharged from hospital. Material and methods. Data apply to 603 (68 died, 535 survived) patients, who had acute coronary syndrome (ACS) with ST-segment elevation (STEMI) and were referred to the Department of Cardiology in PMU Clinical Hospital No 2 in Szczecin. It concerns all the patients who were treated during cardiological accident and emergency in years 2009–2011. Patients who died were excluded from the study. Results. In the analysed group of patients, morphine was administered to 402 patients (75.5%), oxygen was administered to 515 patients (96.8%), nitroglycerine was administered to 393 patients (74.0%) and acetylsalicylic acid was administered to 493 patients (92.5%), after taking into account the primary transport (taking patients directly to the Department of Cardiology) and the secondary transport. Morphine administration has increased over the years (p = 0.0028). In particular years it varied as follows: in 2009 — 67%; in 2010 — 79%; in 2011 — 81%. Oxygen supply has increased as follows: in 2009 — 92%; in 2010 — 98.7%; VII–XII 2011 — 100% (p = 0.00008). The supply of nitroglycerine has decreased: in 2009 — 38%; in 2010 — 17.2%; in 2011 — 24.4% (p = 0.00001). Conclusions. 1. Realisation of MONA scheme in case of ACS STEMI is frequent, regardless of the kind of intervening paramedics team. 2. The supply of medication from MONA scheme, with the exception of nitroglycerine, is not satisfactory for patients with ACS STEMI. 3. In case of inferior wall myocardial infarction diagnosis or in case of uncertainty about the myocardial infarction’s placement, paramedics team should resign from nitroglycerine administration during pre-hospital phase. 4. ECG teletransmission performance in ACS STEMI should be a standard procedure in case of patients with sudden pain in the chest, suggesting recent myocardial infarction, and regardless of a presence of a doctor in a paramedics team.

Abstract

Introduction. Myocardial infarction is a directly life-threatening condition, which is the most frequent consequence of diseases and deaths in highly developed countries. In Poland there are almost hundred thousand of myocardial infarction cases each year and the morbidity increases. The issue of a huge number of myocardial infarctions is meaningful in many countries all over the world. About 30% of all the myocardial infarctions are the ones with ST-segment elevation (ACS STEMI). The purpose of this paper is to analyse how the pre-hospital care has used a standard pharmacological treatment (the so-called MONA scheme) in the area of Szczecin. This medical care was performed by Emergency Medical Service in case of patients who have ACS STEMI, were hospitalised in Pomeranian Medical University’s (PMU’s) Department of Cardiology, survived this period and were discharged from hospital. Material and methods. Data apply to 603 (68 died, 535 survived) patients, who had acute coronary syndrome (ACS) with ST-segment elevation (STEMI) and were referred to the Department of Cardiology in PMU Clinical Hospital No 2 in Szczecin. It concerns all the patients who were treated during cardiological accident and emergency in years 2009–2011. Patients who died were excluded from the study. Results. In the analysed group of patients, morphine was administered to 402 patients (75.5%), oxygen was administered to 515 patients (96.8%), nitroglycerine was administered to 393 patients (74.0%) and acetylsalicylic acid was administered to 493 patients (92.5%), after taking into account the primary transport (taking patients directly to the Department of Cardiology) and the secondary transport. Morphine administration has increased over the years (p = 0.0028). In particular years it varied as follows: in 2009 — 67%; in 2010 — 79%; in 2011 — 81%. Oxygen supply has increased as follows: in 2009 — 92%; in 2010 — 98.7%; VII–XII 2011 — 100% (p = 0.00008). The supply of nitroglycerine has decreased: in 2009 — 38%; in 2010 — 17.2%; in 2011 — 24.4% (p = 0.00001). Conclusions. 1. Realisation of MONA scheme in case of ACS STEMI is frequent, regardless of the kind of intervening paramedics team. 2. The supply of medication from MONA scheme, with the exception of nitroglycerine, is not satisfactory for patients with ACS STEMI. 3. In case of inferior wall myocardial infarction diagnosis or in case of uncertainty about the myocardial infarction’s placement, paramedics team should resign from nitroglycerine administration during pre-hospital phase. 4. ECG teletransmission performance in ACS STEMI should be a standard procedure in case of patients with sudden pain in the chest, suggesting recent myocardial infarction, and regardless of a presence of a doctor in a paramedics team.
Get Citation

Keywords

STEMI, pharmacotherapy, MONA scheme, pre-hospital care

About this article
Title

The analysis of standard pharmacotherapy by emergency medical services (the so-called MONA scheme) in myocardial infarction with ST-segment elevation

Journal

Folia Cardiologica

Issue

Vol 13, No 3 (2018)

Pages

199-203

Published online

2018-07-15

DOI

10.5603/FC.2018.0040

Bibliographic record

Folia Cardiologica 2018;13(3):199-203.

Keywords

STEMI
pharmacotherapy
MONA scheme
pre-hospital care

Authors

Grzegorz Wójcik
Zdzisława Kornacewicz-Jach
Maciej Lewandowski
Dawid Surowicz
Natalia Bobak
Krzysztof Zdziarski
Marek Myślak

References (11)
  1. Dłużniewski M. Kardiologia w praktyce — wybrane zagadnienia. Volume II, 2nd edition. Czelej Publishing House, Lublin 2007.
  2. Mandelzweig L, Battler A, Boyko V, et al. Euro Heart Survey Investigators. The second Euro Heart Survey on acute coronary syndromes: characteristics, treatment, and outcome of patients with ACS in Europe and the Mediterranean Basin in 2004. Eur Heart J. 2006; 27(19): 2285–2293.
  3. Polish ACS Registry. http://www.rejestrozw.republika.pl (12.11.2016).
  4. Roger VL, Go AS, Lloyd-Jones DM, et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Executive summary: heart disease and stroke statistics — 2012 update: a report from the American Heart Association. Circulation. 2012; 125(1): 188–197.
  5. Widimsky P, Zelizko M, Jansky P, et al. CZECH investigators. The incidence, treatment strategies and outcomes of acute coronary syndromes in the "reperfusion network" of different hospital types in the Czech Republic: results of the Czech evaluation of acute coronary syndromes in hospitalized patients (CZECH) registry. Int J Cardiol. 2007; 119(2): 212–219.
  6. Bakhai A, Iñiguez A, Ferrieres J, et al. APTOR trial investigators. Treatment patterns in acute coronary syndrome patients in the United Kingdom undergoing PCI. EuroIntervention. 2011; 6(8): 992–996.
  7. Pfisterer M. Right ventricular involvement in myocardial infarction and cardiogenic shock. Lancet. 2003; 362(9381): 392–394.
  8. Kumar A, Abdel-Aty H, Kriedemann I, et al. Contrast-enhanced cardiovascular magnetic resonance imaging of right ventricular infarction. J Am Coll Cardiol. 2006; 48(10): 1969–1976.
  9. Krstic N, Pavlovic M, Koracevic G, et al. Predictive markers for one-year outcome in patients with STEMI trated with primary Parcutaneus Coronary Intervention (PCI). HealthMED. 2012; 6(3): 916–925.
  10. Clemmensen P, Schoos MM, Lindholm MG, et al. Pre-hospital diagnosis and transfer of patients with acute myocardial infarction--a decade long experience from one of Europe's largest STEMI networks. J Electrocardiol. 2013; 46(6): 546–552.
  11. Rasmussen MB, Frost L, Stengaard C, et al. Diagnostic performance and system delay using telemedicine for prehospital diagnosis in triaging and treatment of STEMI. Heart. 2014; 100(9): 711–715.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

 

Wydawcą serwisu jest  "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl