title: Treating ST elevation myocardial infarction by primary percutaneous coronary intervention, in-hospital thrombolysis and prehospital thrombolysis. An observational study of timelines and outcomes in 625 patients.
abstract: OBJECTIVE
  To describe the effects of implementing of a percutaneous coronary intervention (PPCI) service and compare the distribution of reperfusion therapies 12 months pre and post introduction of PPCI.
  
  
  METHODS
  Observational study with data collected 12 months pre and post-availability of Primary PCI as routine treatment.
  
  
  METHODS
  Lothian region in South-East Scotland. Patients 625 Patients who received reperfusion treatment between December 2005 and November 2007.
  
  
  RESULTS
  PHT was given to 96/328 patients (29%) prior to availability of PPCI as routine treatment. Following routine availability, PPCI was delivered to 248/297 patients who received reperfusion treatment (84%). Median diagnosis-to-PCI balloon inflation time and hospital door-to-balloon time were 84 and 54 min, respectively. Patients received PPCI balloon inflation within 90 min of diagnosis in 60% of cases. PPCI-related delay was 74 min compared with prehospital thrombolysis (PHT). PHT (152 min) and PPCI (166 min) had shorter symptom onset-to-assessment of reperfusion times than in-hospital thrombolysis (IHT) (226 min).
  
  
  CONCLUSIONS
  More than two-thirds of the total-ischaemic-time in (ST-segment elevation myocardial infarction) STEMI occurs before the patient reaches hospital, with less than one-third being accounted for by door-to-needle (IHT) or door-to-balloon (PPCI) time. The magnitude of difference in the time between symptom onset-and-assessment of reperfusion treatment efficacy is short and should be considered, particularly in patients treated with thrombolysis in hospitals without cath-lab facilities. Optimal reperfusion treatment including a combination of PHT, IHT and PPCI, as recommended in international guidelines, is feasible in the UK although the balance between the use of different treatments will differ between urban and rural areas.
authors.affiliation: The Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK. Scott.Mclean@bartsandthelondon.nhs.uk
authors.forename: S
authors.initials: S
authors.lastname: McLean
authors.forename: S
authors.initials: S
authors.lastname: Wild
authors.forename: P
authors.initials: P
authors.lastname: Connor
authors.forename: A D
authors.initials: AD
authors.lastname: Flapan
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D011446:Prospective Studies; D012606:Scotland; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome