A citywide protocol for primary PCI in ST-segment elevation myocardial infarction

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.