A regional system to provide timely access to percutaneous coronary intervention for ST-elevation myocardial infarction

Background - Percutaneous coronary intervention ( PCI) for ST- elevation myocardial infarction ( STEMI) is superior to fibrinolysis when performed in a timely manner in high- volume centers. Recent European trials suggest that transfer for PCI also may be superior to fibrinolysis and increase access to PCI. In the United States, transfer times are consistently long; therefore, many believe a transfer for PCI strategy for STEMI is not practical. Methods and Results - We developed a standardized PCI- based treatment system for STEMI patients from 30 hospitals up to 210 miles from a PCI center. From March 2003 to November 2006, 1345 consecutive STEMI patients were treated, including 1048 patients transferred from non- PCI hospitals. The median first door- to- balloon time for patients < 60 miles ( zone 1) and 60 to 210 miles ( zone 2) from the PCI center was 95 minutes ( 25th and 75th percentiles, 82 and 116 minutes) and 120 minutes ( 25th and 75th percentiles, 100 and 145 minutes), respectively. Despite the high- risk unselected patient population ( cardiogenic shock, 12.3%; cardiac arrest, 10.8%; and elderly [ >= 80 years of age], 14.6%), in- hospital mortality was 4.2%, and median length of stay was 3 days. Conclusions - Rapid transfer of STEMI patients from community hospitals up to 210 miles from a PCI center is safe and feasible using a standardized protocol with an integrated transfer system.