title: A review of a regional primary percutaneous coronary intervention service, with a focus on door to reperfusion times: the 2012 Auckland/Northland experience.
abstract: OBJECTIVE
  Primary percutaneous coronary intervention (PCI) is the optimal management for ST segment elevation myocardial infarction (STEMI) patients. We reviewed the largest primary PCI regional service in New Zealand: the Auckland/Northland service based at Auckland City Hospital, to assess patient management, in particular the door to reperfusion times (DTRTs), and predictors of death in hospital.
  
  
  METHODS
  We obtained patient details from a comprehensive prospective database of all primary PCI patients admitted with STEMI from 1/1/12 to 31/12/12 to the Auckland City Hospital cardiac catheterisation laboratory. Of four District Health Boards (DHBs) within the region, two accessed this regional service at all times, and two accessed the Auckland City Hospital cardiac catheterisation laboratory 'after hours': all times except for 08:00 to 16:00 hours on Monday to Friday.
  
  
  RESULTS
  A total of 401 adult patients underwent a primary PCI at the Auckland City Hospital Regional centre for a STEMI presentation, over the 12 months period. The median patient age was 61 years, 77% were male. Overall 183 (46%) (95% CI 41, 51) patients achieved a DTRT of < 90 mins, and 266 (66%) (95% CI 61, 71) a DTRT of < 120 mins, with a clear geographical influence to these times. Of 27 patients with direct transfer to the catheter laboratory from the community, the DTRT was < 120 mins in 24 (92%) (95% CI 72, 96) patients. In-hospital mortality was 24 (6%) patients (95% CI 4, 9).
  
  
  CONCLUSIONS
  The 2012 Auckland/Northland primary PCI service delivers good outcomes consistent with current Australasian standards. Although geographical isolation complicates door to reperfusion times, these may potentially be improved by more focus on direct transfer to the cardiac catheterisation laboratory, especially directly from the community.
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Aaron
authors.initials: A
authors.lastname: Lin
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Timothy
authors.initials: T
authors.lastname: Oh
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Alawami
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Mark
authors.initials: M
authors.lastname: Webster
authors.affiliation: North Shore Hospital, Auckland, New Zealand.
authors.forename: Seif
authors.initials: S
authors.lastname: El-Jack
authors.affiliation: Middlemore Hospital, Auckland, New Zealand.
authors.forename: Douglas
authors.initials: D
authors.lastname: Scott
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
authors.forename: James
authors.initials: J
authors.lastname: Stewart
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
authors.forename: John
authors.initials: J
authors.lastname: Ormiston
authors.affiliation: North Shore Hospital, Auckland, New Zealand.
authors.forename: Guy
authors.initials: G
authors.lastname: Armstrong
authors.affiliation: North Shore Hospital, Auckland, New Zealand.
authors.forename: Ali
authors.initials: A
authors.lastname: Khan
authors.affiliation: Middlemore Hospital, Auckland, New Zealand.
authors.forename: Patrick
authors.initials: P
authors.lastname: Kay
authors.affiliation: Middlemore Hospital, Auckland, New Zealand.
authors.forename: Wil
authors.initials: W
authors.lastname: Harrison
authors.affiliation: Middlemore Hospital, Auckland, New Zealand.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kerr
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Alastair
authors.initials: A
authors.lastname: McGeorge
authors.affiliation: University of Auckland, Auckland, New Zealand.
authors.forename: Greg
authors.initials: G
authors.lastname: Gamble
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Peter
authors.initials: P
authors.lastname: Ruygrok
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand. Electronic address: chrise@adhb.govt.nz.
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Ellis
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000401:mortality*; D012189:Retrospective Studies
keywords: Door to Reperfusion Time; ECG; Health Care delivery; Primary PCI; STEMI