title: Consistent door-to-balloon times of less than 90 minutes for STEMI patients transferred for primary PCI.
abstract: BACKGROUND
  Recent data from large national registries show that < 15% of patients with ST-elevation myocardial infarction (STEMI) transferred for primary percutaneous intervention (PCI) actually meet the door-to-balloon (D2B) goal of < or = 90 minutes, and only onethird achieve D2B times of < or = 120 minutes. We established a streamlined STEMI protocol to allow rapid transfer of STEMI patients for primary PCI to meet the ACC D2B goal of < or = 90 minutes in at least 75% of the patients.
  
  
  METHODS
  From February 2007 to August 2008, 37 consecutive patients presenting with STEMI to a community hospital in Vermont were transferred 26 miles to the University of Vermont (UVM) for primary PCI. Three time intervals were evaluated: presentation to departure time at the referring hospital, transfer time and UVM PCI time (time from arrival to the cath lab to balloon time). Total D2B time was defined as presentation to the first hospital to first balloon inflation.
  
  
  RESULTS
  The majority of transfers (69%) occurred off-hours. All patients received aspirin and clopidogrel and heparin pre-PCI. Median presentation to departure time at the STEMI referral hospital, total transfer and UVM PCI times were 26 (20, 33), 36 (34, 40) and 20 (16, 22) minutes, respectively. The median D2B time was 82 (77, 91) minutes, with 73% of patients achieving the goal D2B of < or = 90 minutes, and 94% achieving a D2B time of < or = 120 minutes.
  
  
  CONCLUSIONS
  For patients in a rural setting who present with STEMI, transfer of approximately 30 miles for timely primary PCI can be achieved in nearly 75% of patients using a simplified streamlined protocol.
authors.affiliation: Department of Cardiology, University of Vermont, 111 Colchester Avenue, Burlington, VT 05401, USA. bina.ahmed@vtmednet.org
authors.forename: Bina
authors.initials: B
authors.lastname: Ahmed
authors.forename: Stefan
authors.initials: S
authors.lastname: Lischke
authors.forename: Faye
authors.initials: F
authors.lastname: Straight
authors.forename: Prospero
authors.initials: P
authors.lastname: Gogo
authors.forename: Stephen
authors.initials: S
authors.lastname: Leffler
authors.forename: Marc
authors.initials: M
authors.lastname: Kutler
authors.forename: David J
authors.initials: DJ
authors.lastname: Schneider
authors.forename: Harold L
authors.initials: HL
authors.lastname: Dauerman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D006297:Health Services Accessibility / Q000592:standards*; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D010865:Pilot Projects; D012189:Retrospective Studies; D013997:Time Factors; D014187:Transportation of Patients / Q000592:standards*; D014707:Vermont