Expansion of a Regional ST-Segment Elevation Myocardial Infarction System to an Entire State
Background—Despite national guidelines calling for timely coronary artery reperfusion, treatment is often delayed, particularly for patients requiring inter-hospital transfer.
Methods and Results—119 North Carolina hospitals developed coordinated plans to rapidly treat patients with ST segment elevation myocardial infarction (STEMI) according to presentation: walk-in, ambulance, or hospital transfer. 6841 patients with STEMI (3907 directly presenting to 21 percutaneous coronary intervention (PCI) hospitals, 2933 transferred from 98 non-PCI hospitals were treated between July 2008 and December 2009 (age 59 years, 30% women, 19% uninsured, chest pain duration 91 minutes, shock 9.2%). The rate of patients not receiving reperfusion fell from 5.4% to 4.0% (P=0.04). Treatment times for hospital transfer patients substantially improved. First hospital door to device for hospitals that adopted a "transfer for PCI" reperfusion strategy fell from 117 minutes to 103 minutes (P=0.0008), while times at hospitals with a mixed strategy of transfer or fibrinolysis fell from 195 minutes to 138 minutes (P=0.002). Median door to device times for patients presenting directly to PCI hospitals fell from 64 to 59 minutes (P<0.001). EMS-transported patients were most likely to reach door to device goals with 91% treated within 90 minutes and 52% being treated with 60 minutes. Patients treated within guideline goals had a mortality of 2.2% compared to 5.7% for those exceeding guideline recommendations (P<0.001)
Conclusions—By extending regional coordination to an entire state, rapid diagnosis and treatment of STEMI has become an established standard of care independent of health care setting or geographic location.
- Received September 16, 2011.
- Accepted April 24, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited