A regional system to provide timely access to percutaneous coronary intervention for ST-elevation myocardial infarction

• Published in: Circulation (New York, N.Y.) Vol. 116; no. 7; pp. 721 - 728
• Main Authors: HENRY, Timothy D, SHARKEY, Scott W, NEWELL, Marc C, PEDERSEN, Wes R, POULOSE, Anil K, TRAVERSE, Jay H, UNGER, Barbara T, WANG, Yale L, LARSON, David M, BURKE, M. Nicholas, CHAVEZ, Ivan J, GRAHAM, Kevin J, HENRY, Christopher R, LIPS, Daniel L, MADISON, James D, MENSSEN, Katie M, MOONEY, Michael R
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 14.08.2007
• Subjects: Angioplasty, Balloon, Coronary - mortality; Angioplasty, Balloon, Coronary - standards; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Clinical Protocols; Community Health Planning; Coronary heart disease; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Electrocardiography; Female; Heart; Humans; Male; Medical sciences; Middle Aged; Minnesota; Myocardial Infarction - diagnosis; Myocardial Infarction - therapy; Neurology; Outcome and Process Assessment (Health Care); Regional Medical Programs - organization & administration; Time Factors; Vascular diseases and vascular malformations of the nervous system; Minnesota; Myocardial infarction; ST elevation; stents; Cardiovascular disease; Instrumental dilatation; point-of-care systems; Myocardial disease; Coronary heart disease; Stent; Percutaneous route; angioplasty
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.107.694141

Percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) is superior to fibrinolysis when performed in a timely manner in high-volume centers. Recent European trials suggest that transfer for PCI also may be superior to fibrinolysis and increase access to PCI. In the United States, transfer times are consistently long; therefore, many believe a transfer for PCI strategy for STEMI is not practical. We developed a standardized PCI-based treatment system for STEMI patients from 30 hospitals up to 210 miles from a PCI center. From March 2003 to November 2006, 1345 consecutive STEMI patients were treated, including 1048 patients transferred from non-PCI hospitals. The median first door-to-balloon time for patients <60 miles (zone 1) and 60 to 210 miles (zone 2) from the PCI center was 95 minutes (25th and 75th percentiles, 82 and 116 minutes) and 120 minutes (25th and 75th percentiles, 100 and 145 minutes), respectively. Despite the high-risk unselected patient population (cardiogenic shock, 12.3%; cardiac arrest, 10.8%; and elderly [> or =80 years of age], 14.6%), in-hospital mortality was 4.2%, and median length of stay was 3 days. Rapid transfer of STEMI patients from community hospitals up to 210 miles from a PCI center is safe and feasible using a standardized protocol with an integrated transfer system.