An approach to shorten time to infarct artery patency in patients with ST-segment elevation myocardial infarction

Area of Science:

• Cardiology
• Emergency Medicine
• Health Systems Research

Background:

• Acute ST-segment elevation myocardial infarction (STEMI) requires rapid reperfusion therapy.
• Delays in percutaneous coronary intervention (PCI) are associated with poorer patient outcomes.
• Current triage protocols may not optimize direct access to PCI centers.

Purpose of the Study:

• To evaluate a regional strategy aimed at decreasing the time to PCI for STEMI patients.
• To assess the impact of paramedic diagnosis and direct triage on PCI reperfusion times and in-hospital mortality.
• To identify bottlenecks in STEMI patient care pathways.

Main Methods:

• Development of protocols for paramedics and referring hospitals for STEMI identification and direct triage to a single PCI center.
• Assessment of time to PCI reperfusion and in-hospital mortality in 233 consecutive STEMI patients.
• Comparison of outcomes between directly triaged patients, "walk-ins" to the PCI hospital, and those transferred from other emergency departments (EDs).

Main Results:

• 58.3% of directly triaged STEMI patients achieved 90-minute infarct artery patency, compared to 37.5% of "walk-ins" and 5.2% of transferred patients (p <0.001).
• Overall in-hospital mortality was 2.1%, with 0% mortality in paramedic-identified and "walk-in" patients versus 4.3% in transferred patients (p = 0.007).
• Substantial delays persisted for patients initially presenting to non-PCI hospital EDs.

Conclusions:

• Paramedic electrocardiographic diagnosis and direct triage to a prealerted PCI center significantly improve infarct artery patency for STEMI patients.
• This strategy is associated with reduced in-hospital mortality for STEMI.
• Further implementation of paramedic-driven STEMI diagnosis and direct triage may enhance patient outcomes.