Abstract 20339: Influence of a Regional ST-Elevation Myocardial Infarction System on Onset of Chest Pain to Hospital Arrival
Background: Time to treatment is the key determinant of outcome in patients (pts) with ST-elevation myocardial infarction (STEMI). Although the total time to reperfusion (chest pain onset to balloon) is critical, the major focus has been on decreasing door-to-balloon (D2B) times since the time from chest pain onset to hospital arrival is patient dependent and is challenging to impact. During the development of a regional STEMI system, we performed extensive training of health care professionals and physicians involved in emergency medical services, emergency departments and rural and community hospitals. In addition, we focused on local community education to increase community awareness of STEMI as well as the involvement of the local community hospital in a regional STEMI system. We examined the effect of a regional STEMI program on the components of total reperfusion time.
Methods/Results: The Level 1 MI program is a regional program using a standardized protocol for PCI in STEMI pts in 32 rural and community hospitals. Pts at the PCI hospital and Zone 1 (0-60 miles from PCI center) receive primary PCI. Pts in Zone 2 (60-210 miles from PCI hospital) receive a pharmaco-invasive approach. The results of key time segments and in hospital mortality for 2625 consecutive pts from 2003 to 2009 are included in Table 1. Times are reported as median and interquartile range (IQR).
Conclusion: Local community education in rural/community hospitals is the most likely reason for the significantly shorter chest pain onset to hospital arrival times in Zone 1 and Zone 2 hospitals. As expected, total D2B times are longer in transferred pts, but the overall reperfusion time is mitigated by the shorter chest pain onset to hospital arrival. For example, in Zone 1 pts, while the median D2B is 32 minutes longer, the total reperfusion time is only 19 minutes longer. This may help explain the lack of difference in mortality in the pts transferred despite longer D2B times.
- © 2010 by American Heart Association, Inc.