title: Rural Patient Access to Primary Percutaneous Coronary Intervention Centers is Improved by a Novel Integrated Telemedicine Prehospital System.
abstract: BACKGROUND
  As per American Heart Association/American College of Cardiology guidelines, the delay between first medical contact and balloon inflation should not exceed 90 min for primary percutaneous coronary intervention (PCI). In North America, few prehospital systems have been developed to grant rural populations timely access to PCI.
  
  
  OBJECTIVE
  The objective of the present study was to evaluate the ability of an ST-segment elevation myocardial infarction (STEMI) system serving suburban and rural populations to achieve the recommended 90-min interval benchmark for PCI.
  
  
  METHODS
  A prehospital telemedicine program was implemented in a rural and suburban region of the Quebec province. Three patient groups with STEMI were created according to trajectory: 1) patients already en route to a PCI center, 2) patients initially directed to the nearest hospital who were subsequently diverted to a PCI center during transport, and 3) patients directed to the nearest hospital without transfer for PCI. Time intervals were compared across groups.
  
  
  RESULTS
  Of the 208 patients diagnosed with STEMI, 14.9% were already on their way to a hospital with PCI capabilities, 75.0% were rerouted to a PCI center, and 10.1% were directed to the nearest local hospital. All patients but one arrived at the PCI center within the 60-min prehospital care interval, considering an additional 30 min for balloon inflation at the PCI center.
  
  
  CONCLUSIONS
  This study demonstrated that a regionalized prehospital system for STEMI patients could achieve the recommended 90-min interval benchmark for PCI, while giving timely access to PCI to rural populations that would not otherwise have access to this treatment.
authors.affiliation: Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis, Lévis, Québec, Canada.
authors.forename: Alain
authors.initials: A
authors.lastname: Tanguay
authors.affiliation: Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis, Lévis, Québec, Canada; Laval University, Québec, Québec, Canada.
authors.forename: Renée
authors.initials: R
authors.lastname: Dallaire
authors.affiliation: Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis, Lévis, Québec, Canada.
authors.forename: Denise
authors.initials: D
authors.lastname: Hébert
authors.affiliation: Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis, Lévis, Québec, Canada.
authors.forename: François
authors.initials: F
authors.lastname: Bégin
authors.affiliation: Centre hospitalier affilié universitaire Hôtel-Dieu de Lévis, Lévis, Québec, Canada; Laval University, Québec, Québec, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Fleet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002300:Cardiac Care Facilities; D004562:Electrocardiography; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000592:standards* / Q000706:statistics & numerical data*; D011792:Quebec; D019035:Rural Health Services / Q000458:organization & administration*; D019036:Suburban Health Services / Q000458:organization & administration*; D017216:Telemedicine / Q000458:organization & administration*; D061665:Time-to-Treatment
keywords: STEMI; emergency medicine; rural health; telemedicine