Expansion of a regional ST-segment-elevation myocardial infarction system to an entire state.

Authors

• James G Jollis
• Hussein R Al-Khalidi
• Lisa Monk
• Mayme L Roettig
• J Lee Garvey
• Akinyele O Aluko
• B Hadley Wilson
• Robert J Applegate
• Greg Mears
• Claire C Corbett
• Christopher B Granger

Publication/Presentation Date

7-10-2012

Abstract

BACKGROUND: Despite national guidelines calling for timely coronary artery reperfusion, treatment is often delayed, particularly for patients requiring interhospital transfer.

METHODS AND RESULTS: One hundred nineteen North Carolina hospitals developed coordinated plans to rapidly treat patients with ST-segment-elevation myocardial infarction according to presentation: walk-in, ambulance, or hospital transfer. A total of 6841 patients with ST-segment-elevation myocardial infarction (3907 directly presenting to 21 percutaneous coronary intervention hospitals, 2933 transferred from 98 non-percutaneous coronary intervention hospitals) were treated between July 2008 and December 2009 (age, 59 years; 30% women; 19% uninsured; chest pain duration, 91 minutes; shock, 9.2%). The rate of patients not receiving reperfusion fell from 5.4% to 4.0% (P=0.04). Treatment times for hospital transfer patients substantially improved. First-hospital-door-to-device time for hospitals that adopted a "transfer for percutaneous coronary intervention" reperfusion strategy fell from 117 to 103 minutes (P=0.0008), whereas times at hospitals with a mixed strategy of transfer or fibrinolysis fell from 195 to 138 minutes (P=0.002). Median door-to-device times for patients presenting directly to PCI hospitals fell from 64 to 59 minutes (P< 0.001). Emergency medical services-transported patients were most likely to reach door-to-device goals, with 91% treated within 90 minutes and 52% being treated with 60 minutes. Patients treated within guideline goals had a mortality of 2.2% compared with 5.7% for those exceeding guideline recommendations (P< 0.001).

CONCLUSION: Through extension of regional coordination to an entire state, rapid diagnosis and treatment of ST-segment-elevation myocardial infarction has become an established standard of care independently of healthcare setting or geographic location.

Volume

126

Issue

2

First Page

189

Last Page

195

ISSN

1524-4539

Published In/Presented At

Jollis, J. G., Al-Khalidi, H. R., Monk, L., Roettig, M. L., Garvey, J. L., Aluko, A. O., Wilson, B. H., Applegate, R. J., Mears, G., Corbett, C. C., Granger, C. B., & Regional Approach to Cardiovascular Emergencies (RACE) Investigators (2012). Expansion of a regional ST-segment-elevation myocardial infarction system to an entire state. Circulation, 126(2), 189–195. https://doi.org/10.1161/CIRCULATIONAHA.111.068049

Disciplines

Medicine and Health Sciences

PubMedID

22665718

Department(s)

Department of Emergency Medicine

Document Type

Article