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


RESULTS
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.


CONCLUSIONS
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.
Henry
Timothy D
TD
Minneapolis Heart Institute Foundation, 920 E 28th St, Ste 40, Minneapolis, MN 55407, USA. henry003@umn.edu
Sharkey
Scott W
SW
Burke
M Nicholas
MN
Chavez
Ivan J
IJ
Graham
Kevin J
KJ
Henry
Christopher R
CR
Lips
Daniel L
DL
Madison
James D
JD
Menssen
Katie M
KM
Mooney
Michael R
MR
Newell
Marc C
MC
Pedersen
Wes R
WR
Poulose
Anil K
AK
Traverse
Jay H
JH
Unger
Barbara T
BT
Wang
Yale L
YL
Larson
David M
DM
D015906:Angioplasty, Balloon, Coronary / Q000401:mortality / Q000592:standards*; D002985:Clinical Protocols; D018672:Community Health Planning; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D012041:Regional Medical Programs / Q000458:organization & administration*; D013997:Time Factors