Document Detail

The Impact of a Statewide Pre-Hospital STEMI Strategy to Bypass Hospitals without Percutaneous Coronary Intervention Capability on Treatment Times.
MedLine Citation:
PMID:  23275382     Owner:  NLM     Status:  Publisher    
BACKGROUND: The ultimate treatment goal for ST-segment elevation myocardial infarction (STEMI) is rapid reperfusion via primary percutaneous intervention (PCI). North Carolina has adopted a statewide STEMI referral strategy that advises paramedics to "bypass" local hospitals and transport STEMI patients directly to a PCI-capable hospital, even if a non-PCI-capable hospital is closer. METHODS AND RESULTS: We assessed emergency medical services (EMS) adherence to this STEMI protocol, as well as subsequent associations with patient treatment times and outcomes by linking data from the ACTION Registry-GWTG and a statewide EMS data system from 06/2008-09/2010 for all STEMI patients. Patients were divided into those: (1) transported directly to a PCI hospital, thereby bypassing a closer non-PCI hospital; and (2) first taken to a closer non-PCI center and later transferred to a PCI hospital. Among 6010 STEMI patients, 1288 were eligible and included in our study cohort. Of these, 826 (64%) were transported directly to a PCI facility, whereas 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 first medical contact-to-PCI times within guideline recommendations CONCLUSIONS: We found that patients who were sent directly to a PCI center had significantly shorter time to reperfusion.
Emil L Fosbol; Christopher B Granger; James G Jollis; Lisa Monk; Li Lin; Barbara L Lytle; Ying Xian; J Lee Garvey; Greg Mears; Claire C Corbett; Eric D Peterson; Seth W Glickman
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-30
Journal Detail:
Title:  Circulation     Volume:  -     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-31     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1 Duke Clinical Research Institute, Duke University Medical Center, Durham, NC;
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