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MI patients initially taken to PCI hospitals received faster treatment
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Patients with MI sent directly to a percutaneous coronary intervention-equipped hospital had better rapid reperfusion times and lower mortality vs. those transferred for treatment later, according to research presented at the American Heart Association’s Quality of Care and Outcomes Research 2012 Scientific Sessions.
As part of a statewide STEMI regionalization program, North Carolina recently implemented emergency medical services (EMS) protocols that encourage STEMI patients to be sent directly to a PCI-capable hospital. To assess EMS adherence to this protocol, researchers reviewed North Carolina’s EMS records from June 2008 to September 2010 and linked those to a clinical registry of patients with STEMI.
Of the 1,224 STEMI patients who met the study’s specifications, 63% went directly to a PCI-capable hospital (bypass group) and 37% stopped first at a non-PCI hospital before being transferred for a PCI procedure (non-bypass group).
The study revealed:
- Time from first medical contact to initial reperfusion therapy averaged 94 minutes for the bypass group and 124 minutes for the non-bypass group (P<.0001).
- Time from first medical contact to PCI averaged 95 minutes for the bypass group and 179 minutes for the non-bypass group for patients who received only PCI (P<.0001).
- Crude in-hospital mortality was lower in the bypass group vs. the non-bypass group (6.3% vs. 9.4%; P=.046).
- Patients in the bypass group were almost three times as likely to get treatment within guideline recommendations vs. the non-bypass group.
In other results, adjusted predictors of undergoing bypass included previously receiving a pre-hospital 12-lead electrocardiogram (OR=2.14; 95% CI, 1.1-4.15); chief complaint of chest pain (OR=2.08; 95% CI, 1.46-2.95); cardiogenic shock (OR=1.82; 95% CI, 1.22-2.72); prior history of PCI (OR=1.66; 95% CI, 1.11-2.5); and white race (OR=1.37; 95% CI, 1.02-1.84).
“Our results suggest that when logistically feasible, EMS should transfer STEMI patients directly to the nearest PCI-capable hospital,” Emil L. Fosbal, MD, PhD, a research fellow at Duke University, stated in an AHA press release.
For more information:
- Fosbal EL. Presentation #4. Presented at: the American Heart Association’s Quality of Care and Outcomes Research 2012 Scientific Sessions; May 9-11, 2012; Atlanta.
Disclosure: Dr. Fosbal reports no relevant financial disclosures.