A citywide protocol for primary PCI in ST-segment elevation myocardial infarction
Michel R Le May1, Derek Y So, Richard Dionne
1University of Ottawa Heart Institute, Ottawa, ON, Canada. mlemay@ottawaheart.ca
Insights
Prompting ST-segment elevation myocardial infarction care, paramedics independently transporting patients to primary PCI centers achieved guideline door-to-balloon times more often than emergency department referrals. This improves timely intervention for heart attack patients.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Systems Research
Background:
- Primary percutaneous coronary intervention (PCI) is superior to fibrinolysis for ST-segment elevation myocardial infarction (STEMI) when performed promptly.
- A door-to-balloon time of less than 90 minutes is the benchmark for timely primary PCI.
- Achieving this benchmark through regional strategies remains uncertain.
Purpose of the Study:
- To evaluate an integrated metropolitan approach for STEMI patients requiring primary PCI.
- To compare door-to-balloon times for STEMI patients referred directly from the field by paramedics versus those referred from emergency departments.
Main Methods:
- An integrated metropolitan strategy was implemented, referring all STEMI patients to a specialized primary PCI center.
- Paramedics trained in electrocardiogram interpretation independently triaged and transported patients.
- Door-to-balloon times were compared between field-referred and emergency department-referred patients.
Main Results:
- Of 344 STEMI patients, 135 were referred from the field and 209 from emergency departments; primary PCI was performed in 93.6%.
- Median door-to-balloon time was significantly shorter for field referrals (69 minutes) compared to emergency department referrals (123 minutes; P<0.001).
- Door-to-balloon times <90 minutes were achieved in 79.7% of field referrals versus 11.9% of emergency department referrals (P<0.001).
Conclusions:
- Trained paramedics independently triaging and transporting STEMI patients directly to a primary PCI center resulted in more frequent achievement of guideline door-to-balloon times.
- This approach demonstrates the effectiveness of regional strategies in improving timely reperfusion therapy for STEMI.
Background:
If primary percutaneous coronary intervention (PCI) is performed promptly, the procedure is superior to fibrinolysis in restoring flow to the infarct-related artery in patients with ST-segment elevation myocardial infarction. The benchmark for a timely PCI intervention has become a door-to-balloon time of less than 90 minutes. Whether regional strategies can be developed to achieve this goal is uncertain.
Methods:
We developed an integrated-metropolitan-area approach in which all patients with ST-segment elevation myocardial infarction were referred to a specialized center for primary PCI. We sought to determine whether there was a difference in door-to-balloon times between patients who were referred directly from the field by paramedics trained in the interpretation of electrocardiograms and patients who were referred by emergency department physicians.
Results:
Between May 1, 2005, and April 30, 2006, a total of 344 consecutive patients with ST-segment elevation myocardial infarction were referred for primary PCI: 135 directly from the field and 209 from emergency departments. Primary PCI was performed in 93.6% of patients. The median door-to-balloon time was shorter in patients referred from the field (69 minutes; interquartile range, 43 to 87) than in patients needing interhospital transfer (123 minutes; interquartile range, 101 to 153; P<0.001). Door-to-balloon times of less than 90 minutes were achieved in 79.7% of patients who were transferred from the field and in 11.9% of those transferred from emergency departments (P<0.001).
Conclusions:
Guideline door-to-balloon-times were more often achieved when trained paramedics independently triaged and transported patients directly to a designated primary PCI center than when patients were referred from emergency departments.
More Related Videos
10:01Improvement of a Closed Chest Porcine Myocardial Infarction Model by Standardization of Tissue and Blood Sampling Procedures
Published on: March 12, 2018
05:26Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:26Angina IV: Management