The Impact of a Statewide Pre-Hospital STEMI Strategy to Bypass Hospitals without Percutaneous Coronary Intervention Capability on Treatment Times
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

CIRCULATIONAHA.112.118463 Published online before print December 30, 2012,

Abstract

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.