Implementation of Specialty Centers for Patients with ST-Segment Elevation Myocardial Infarction

BACKGROUND: Early percutaneous coronary intervention (PCI) has been shown to be superior to fibrinolytic therapy and is associated with reduced morbidity and mortality for patients with ST-segment elevation myocardial infarction (STEMI). OBJECTIVE: To determine the performance of a regional system with prehospital 12-lead electrocardiogram (ECG) identification of STEMI patients and direct paramedic transport to STEMI receiving centers (SRCs) for provision of primary PCI. METHODS: This was a prospective study evaluating the first year of implementation of a regional SRC network to determine the key time intervals for patients identified with STEMI in the prehospital setting. Results. During the 12-month study period, 1,220 patients with a suspected STEMI were identified on prehospital 12-lead ECG, of whom 734 (60%) underwent emergency PCI. A door-to-balloon time of 90 minutes or less was achieved for 651 (89%) patients, and 459 (62.5%) had EMS-patient contact-to-balloon times <or= 90 minutes. Transport of suspected STEMI patients to an SRC resulted in ambulance diversion from a closer ED for 31% of patients and a median increase in transport time of 3.8 minutes. CONCLUSION: Door-to-balloon times within the 90-minute benchmark were achieved for almost 90% of STEMI patients transported by paramedics after implementing our regionalized SRC system.