Study Supports Statewide Strategy Sending STEMI Patients to PCI-Capable Hospitals

February 5, 2013—In Circulation, Emil L. Fosbol, MD, et al published findings from an analysis of the impact of North Carolina's statewide referral strategy that advises paramedics to bypass local hospitals and to transport ST-segment elevation myocardial infarction (STEMI) patients directly to a hospital with percutaneous coronary intervention (PCI) capability, even if a non-PCI-capable hospital is closer (2013;127:604–612). The investigators found that patients who were sent directly to a PCI center had significantly shorter time to reperfusion.

As summarized in Circulation, the investigators assessed the adherence of emergency medical services to this STEMI protocol, as well as subsequent associations with patient treatment times and outcomes, by linking data from the Acute Coronary Treatment and Intervention Outcomes Network Registry—Get With the Guidelines and a statewide emergency medical services data system from June 2008 to September 2010 for all patients with STEMI.

Patients were divided into those transported directly to a PCI hospital (thereby bypassing a closer, non-PCI hospital) and those first taken to a closer, non-PCI center and later transferred to a PCI hospital. Among 6,010 patients with STEMI, 1,288 were eligible and included in our study cohort. Of these eligible patients, 826 (64%) were transported directly to a PCI facility and 462 (36%) were first taken to a non-PCI hospital and later transferred. In a multivariable model, increase in differential driving time and cardiac arrest were associated with a lesser likelihood of being taken directly to a PCI center, whereas a history of PCI was associated with a higher likelihood of being taken directly to a PCI center. Patients sent directly to a PCI center were more likely to have times between first medical contact and PCI within guideline recommendations, reported the investigators in Circulation.