Abstract 1993: Can STEMI Patients Transferred For 1° Angioplasty Receive Treatment Within 90-Minutes in a Rural Setting?
Introduction: For STEMI patients (pts) presenting to non-PCI hospitals, the feasibility of rapid transfer for 1° PCI within 90 minutes of initial presentation is unclear.
Hypothesis: A rapid triage/transfer/treatment protocol can provide 1° PCI ≤ 90 minutes to STEMI pts presenting to rural community hospitals.
Methods: On Jan 1, 2005 we implemented a STEMI program in rural central PA to transport STEMI pts up to 25 minutes away by helicopter. One call from a community hospital to an emergency physician at the PCI center leads to dispatch of a helicopter and simultaneous activation of the cath lab. Local hospitals were encouraged to meet time milestones to diagnose, administer specific medical therapies and transfer pts rapidly. Incremental improvements in the program were made since implementation. We prospectively recorded presentation (Door1) to helicopter dispatch (Dis), Dispatch to cath lab arrival (Door 2), and Door2 to wire cross (WC) times for all patients using flight logs, cath lab logs, EKGs, and triage notes. Times are reported as medians. Times since implementation are compared to times for the 12 months before implementation.
Results: STEMI pts transferred from 12 hospitals for 1° PCI between Jan. 1, 2005 and Mar. 31, 2007 (n = 298) were compared to patients transferred for STEMI PCI in the year before program implementation (n = 110) (Table⇓). Comparing pre-program times to 2007 times, overall Door1 => WC times decreased from 205 minutes to 102 minutes. Of the 8 most frequently referring community hospitals, 4 achieved median Door1 => WC times < 120 minutes and 2 of these achieved Door1 => WC times under 90 minutes (Hosp A: 221 => 102 minutes, Hosp B: 202 min => 64 min, Hosp C: 188 min => 104 min, Hosp C: 172 min => 87 min). In 2007, 28% of transfer pts have Door1=> WC times under 90 min and 60% have Door1 => WC times under 120 minutes.
Conclusion: 1° PCI can be delivered rapidly to STEMI pts presenting to community hospitals without on-site PCI in a rural area, often < 90 minutes.