title: Transport time and care processes for patients transferred with ST-segment-elevation myocardial infarction: the reperfusion in acute myocardial infarction in Carolina emergency rooms experience.
abstract: BACKGROUND
  For patients with ST-segment elevation myocardial infarction transferred for primary percutaneous coronary intervention, guidelines have called for device activation within 90 minutes of initial presentation. Fewer than 20% of transferred patients are treated in such a timely fashion. We examine the association between transfer drive times and door-to-device (D2D) times in a network of North Carolina hospitals. We compare the feasibility of timely percutaneous coronary intervention using ground versus air transfer.
  
  
  RESULTS
  We perform a retrospective analysis of the relationship between transfer drive times and D2D times in a 119-hospital ST-segment-elevation myocardial infarction statewide network. Between July 2008 and December 2009, 1537 ST-segment-elevation myocardial infarction patients underwent interhospital transfer for reperfusion via primary percutaneous coronary intervention. For ground transfers, median D2D time was 93 minutes for drive times ≤30 minutes, 117 minutes for drive times of 31 to 45 minutes, and 121 minutes for drive times >45 minutes. For air transfers, median D2D time was 125 minutes for drive times of 31 to 45 minutes and 138 minutes for drive times >45 minutes. Helicopter transport was associated with longer door-in door-out times and, ultimately, was associated with median D2D times that exceeded guideline recommendations, no matter the transfer drive time category.
  
  
  CONCLUSIONS
  In a well-developed ST-segment-elevation myocardial infarction system, D2D times within 90 to 120 minutes appear most feasible for hospitals within 30-minute transfer drive time. Helicopter transport did not offer D2D time advantages for transferred STEMI patients. This finding appears to be attributable to comparably longer door-in door-out times for air transfers.
authors.affiliation: Duke Clinical Research Institute, Duke University, Durham, NC 27705, USA. daniel.munoz@duke.edu
authors.forename: Daniel
authors.initials: D
authors.lastname: Muñoz
authors.forename: Mayme L
authors.initials: ML
authors.lastname: Roettig
authors.forename: Lisa
authors.initials: L
authors.lastname: Monk
authors.forename: Hussein
authors.initials: H
authors.lastname: Al-Khalidi
authors.forename: James G
authors.initials: JG
authors.lastname: Jollis
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Granger
mesh_terms: D017732:Air Ambulances / Q000592:standards / Q000706:statistics & numerical data; D000552:Ambulances / Q000592:standards / Q000706:statistics & numerical data; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005260:Female; D005342:Fibrinolysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015425:Myocardial Reperfusion; D009657:North Carolina / Q000453:epidemiology; D010360:Patient Transfer / Q000592:standards / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies; D061665:Time-to-Treatment / Q000592:standards / Q000706:statistics & numerical data*; D014187:Transportation of Patients / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data*