title: Implementation of specialty centers for patients with ST-segment elevation myocardial infarction.
abstract: BACKGROUND
  Early percutaneous coronary intervention (PCI) has been shown to be superior to fibrinolytic therapy and is associated with reduced morbidity and mortality for patients with ST-segment elevation myocardial infarction (STEMI).
  
  
  OBJECTIVE
  To determine the performance of a regional system with prehospital 12-lead electrocardiogram (ECG) identification of STEMI patients and direct paramedic transport to STEMI receiving centers (SRCs) for provision of primary PCI.
  
  
  METHODS
  This was a prospective study evaluating the first year of implementation of a regional SRC network to determine the key time intervals for patients identified with STEMI in the prehospital setting. Results. During the 12-month study period, 1,220 patients with a suspected STEMI were identified on prehospital 12-lead ECG, of whom 734 (60%) underwent emergency PCI. A door-to-balloon time of 90 minutes or less was achieved for 651 (89%) patients, and 459 (62.5%) had EMS-patient contact-to-balloon times <or= 90 minutes. Transport of suspected STEMI patients to an SRC resulted in ambulance diversion from a closer ED for 31% of patients and a median increase in transport time of 3.8 minutes.
  
  
  CONCLUSIONS
  Door-to-balloon times within the 90-minute benchmark were achieved for almost 90% of STEMI patients transported by paramedics after implementing our regionalized SRC system.
authors.affiliation: Keck School of Medicine of the University of Southern California, Los Angeles, California 90033, USA. eckstein@usc.edu
authors.forename: Marc
authors.initials: M
authors.lastname: Eckstein
authors.forename: William
authors.initials: W
authors.lastname: Koenig
authors.forename: Amy
authors.initials: A
authors.lastname: Kaji
authors.forename: Richard
authors.initials: R
authors.lastname: Tadeo
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization; D019992:Databases as Topic; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015425:Myocardial Reperfusion; D011446:Prospective Studies; D013997:Time Factors