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(Circulation. 2006;113:1159-1161.)
© 2006 American Heart Association, Inc.

Editorial

Regionalized Care for Patients With ST-Elevation Myocardial Infarction

It’s Closer Than You Think

Alice K. Jacobs, MD

From Section of Cardiology, Boston Medical Center, Boston, Mass.

Correspondence to Alice K. Jacobs, MD, Section of Cardiology, Boston Medical Center, 88 E Newton St, Boston, MA 02118. E-mail alice.jacobs@bmc.org

Key Words: Editorials • myocardial infarction • reperfusion

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The overwhelming enthusiasm for primary percutaneous coronary intervention (PCI) as the preferred reperfusion strategy for patients with ST-segment elevation myocardial infarction (STEMI) is fueled by evidence from randomized trials suggesting that PCI is superior to fibrinolytic therapy alone in reducing the rates of death, reinfarction, intracranial bleeding, reocclusion of the infarct artery, and recurrent ischemia even if performed when transport to a hospital with PCI capability is required.^1,2 In the United States, this enthusiasm is tempered by the reality that approximately one third of patients do not receive any reperfusion therapy despite its availability and the absence of any contraindication, and that only a minority (18%) of patients with STEMI receive primary PCI.³ Furthermore, of those patients treated with primary PCI, fewer than 40% undergo reperfusion of the infarct artery within 90 minutes after arrival to the initial hospital,⁴ a goal advocated by the American College of Cardiology/American Heart Association guidelines.⁵ Of the nearly 5000 acute-care hospitals in this country, &2200 have catheterization laboratories. Among those, only 1200 are capable of performing PCI, which makes it challenging for several states to provide primary PCI to selected patients in a timely fashion.⁶ In fact, several regions are beginning to organize and monitor both transfer and triage protocols for patients with STEMI.^7,8

Article p 1189

In the hope of increasing the availability of timely primary PCI to a greater number of patients, a debate has ensued over the concept of regionalized care for patients with STEMI.^9,10 Proponents of regionalization cite the reduction . . . [Full Text of this Article]

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