title: Door-to-balloon times under 90 min can be routinely achieved for patients transferred for ST-segment elevation myocardial infarction percutaneous coronary intervention in a rural setting.
abstract: OBJECTIVE
  The purpose of this study was to demonstrate the feasibility of routine transfer of ST-segment elevation myocardial infarction (STEMI) patients to achieve percutaneous coronary intervention (PCI) in less than 90 min from presentation.
  
  
  BACKGROUND
  Many PCI hospitals have achieved routine door-to-balloon times under 90 min for patients with STEMI presenting directly to the hospital. However, few patients transferred from a non-PCI center undergo PCI within 90 min of presentation.
  
  
  METHODS
  Our rural PCI hospital implemented a program in 2005 for rapid triage, transfer, and treatment of STEMI patients and made additional improvements in 2006 and 2007. Intervals between milestones in the STEMI triage/transfer/treatment process were assessed before and after implementation of the program.
  
  
  RESULTS
  During the 5-year study period, 676 patients with 687 STEMIs were transferred from 19 community hospitals and underwent PCI. Median door-to-balloon time decreased from 189 min to 88 min (p < 0.001). The time intervals reflecting efficiency of the referring hospitals, transfer services, and PCI hospital all significantly improved. In 2008, median door-to-balloon times were <90 min for 6 of the 7 most frequently referring hospitals. Delays during off-hours presentation in 2004 were abolished after the program was implemented in 2005. In-hospital mortality decreased from 6% before to 3% after implementation of the program. In multivariate modeling, presentation before initiation of the STEMI program predicted increased risk of in-hospital mortality (odds ratio: 3.74, 95% confidence interval: 1.22 to 11.51, p = 0.021).
  
  
  CONCLUSIONS
  A program of rapid triage, transfer, and treatment of STEMI patients presenting to non-PCI hospitals can reduce in-hospital mortality and produce progressive improvements in door-to-balloon time such that median door-to-balloon times under 90 min are feasible.
authors.affiliation: Department of Cardiology, Geisinger Medical Center, Danville, Pennsylvania 17822, USA. Jblankenship@geisinger.edu
authors.forename: James C
authors.initials: JC
authors.lastname: Blankenship
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Scott
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Skelding
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Haldis
authors.forename: Karen
authors.initials: K
authors.lastname: Tompkins-Weber
authors.forename: Marie Y
authors.initials: MY
authors.lastname: Sledgen
authors.forename: Michael A
authors.initials: MA
authors.lastname: Donegan
authors.forename: Jeremy W
authors.initials: JW
authors.lastname: Buckley
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Sartorius
authors.forename: John McB
authors.initials: JM
authors.lastname: Hodgson
authors.forename: Peter B
authors.initials: PB
authors.lastname: Berger
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000401:mortality / Q000592:standards; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006780:Hospitals, Rural / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D010360:Patient Transfer / Q000379:methods* / Q000592:standards; D012189:Retrospective Studies; D013997:Time Factors