Primary PCI Not Always the Best Reperfusion Strategy?

Abstract

For patients with an ST-elevation myocardial infarction (STEMI), primary PCI is the preferred reperfusion modality.¹ Primary PCI, however, requires a catheterization lab and 24/7 availability of an experienced team. Worldwide, only a minority of STEMI patients presents directly to a PCI-capable hospital. Most patients are first seen by an ambulance crew or at the emergence room of a non-PCI-capable hospital. While in some regions almost all STEMI patients can be transferred to a primary PCI center within guideline-recommended time, in many other regions across the world timely transport remains a major issue because of distance, weather conditions, traffic and, very often, a poor organization of the emergency medical system (EMS). The organization of regional transfer can indeed be complex and costly. It requires close collaboration between ambulance systems, emergency departments and catheterization labs.²