A Citywide Protocol for Primary PCI in ST-Segment Elevation Myocardial Infarction

May, Michel R. Le; So, Derek; Dionne, Richard; Glover, Chris; Froeschl, Michael; Wells, George A.; Davies, Richard F.; Sherrard, Heather; Maloney, Justin; Marquis, Jean-François; O'Brien, Edward R.; Trickett, John; Poirier, P.; Ryan, Sheila; Ha, Andrew C.T.; Joseph, Phil G; Labinaz, Marino

doi:10.1056/nejmoa073102

Cited by 360 publications

(85 citation statements)

References 30 publications

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“…Accordingly, many studies have made an effort to reduce the door-to-balloon time. Some studies suggest skipping local hospitals in favor of direct referral to PCI-capable hospitals via pre-hospital electrocardiogram diagnosis [8,9]. This strategy is very effective and shows better clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, if a patient with STEMI arrives at a non-PCI-capable hospital, they should be transferred to a PCI-capable hospital for primary PCI if the anticipated first medical contactto-device time at that hospital does not exceed 120 min [5,6]. In fact, only 12% of transferred patients were treated with PCI within 90 min of the time from the first medical contact [8]. Therefore, patient transfer can be a cause of significantly delayed treatment.…”

Section: Introductionmentioning

confidence: 99%

“…However, several studies have shown that pre-hospital electrocardiographic diagnosis and direct referral to PCI-capable hospitals decrease the time delay in treating patients with STEMI [1,8,9]. Quality improvement strategies have reduced door-to-balloon times for direct-arrival patients with STEMI undergoing primary PCI.…”

Section: Introductionmentioning

confidence: 99%

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The impact of transferring patients with ST-segment elevation myocardial infarction to percutaneous coronary intervention-capable hospitals on clinical outcomes

et al. 2016

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Background: Primary percutaneous coronary intervention (PCI) is recommended for ST-segment elevation myocardial infarction (STEMI) patients (194 vs. 90 min, p < 0.001). The median door-toballoon time was significantly shorter in the transfer group vs. the direct-arrival group (75 vs. 91 min, p < 0.001). Total death and the composite of MACE were not significantly different during hospitalization (5.1 vs. 3.9%, p = 0.980; 5.4 vs. 4.8%, p = 0.435, respectively) and at 1-year (8.2 vs. 6.6%, p = 0.075; 13.7 vs. 13.9%, p = 0.922, respectively (Cardiol J 2016; 23, 3: 289-295)

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The impact of transferring patients with ST-segment elevation myocardial infarction to percutaneous coronary intervention-capable hospitals on clinical outcomes

et al. 2016

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“…9 Many strategies have been successfully applied to shorten door-to-balloon time before catheterization laboratory arrival but few have been studied to reduce delays inherent to the procedure. [10][11][12][13][14][15][16][17] Hereof, there is scarce data on the impact of obtaining a complete diagnostic angiography before PPCI. Our study sought to determine whether a strategy of performing culprit-vessel revascularization before obtaining contralateral or complete diagnostic angiography could be associated with a reduction in delays and outcomes in ST-segment-elevation myocardial infarction (STEMI) patients.…”

mentioning

confidence: 99%

Culprit Vessel Revascularization Prior to Diagnostic Angiography as a Strategy to Reduce Delays in Primary Percutaneous Coronary Intervention

Couture

Bérubé

Dalery³

et al. 2016

Circ: Cardiovascular Interventions

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were studied. After excluding patients with prior coronary artery bypass surgery, 925 patients were included in the analysis. Patients were classified into 3 groups according to the as-treated revascularization strategy: culprit-vessel revascularization first, contralateral angiography first, or complete angiography first. Propensity score matching was used to minimize difference in clinical characteristics between groups. Predictors of culprit-vessel first revascularization were anterior/lateral infarct location and absence of diabetes mellitus. After propensity score matching, the median vascular access-to-balloon time was 4 to 6 minutes shorter with a culprit-vessel revascularization first strategy. This reduction in time to reperfusion increased the proportion of patients treated within recommended delays. However, there was no significant difference in 30-day clinical outcomes associated with these delays reduction. Conclusions-Performing culprit-vessel primary percutaneous coronary intervention before contralateral or complete diagnostic angiography is associated with a statistically significant reduction in vascular access-to-balloon time, although the 4-to 6-minute difference is unlikely to be clinically relevant. This small but significant reduction could translate in an augmentation in the proportion of patients treated within recommended delays. (Circ Cardiovasc Interv. 2016;9:e003510.

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“…(2008) in France, and Le May et al. (2008) in Ontario, Canada reported decreased mortality with regionalized care. The Denmark report is an anecdotal assertion of an historic low; the other three reports are comparisons with baseline performance.…”

Section: Resultsmentioning

confidence: 99%

Effectiveness of regionalized systems for stroke and myocardial infarction

et al. 2015

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BackgroundAcute ischemic stroke (AIS) and ST‐segment elevation myocardial infarction (STEMI) are ischemic emergencies. Guidelines recommend care delivery within formally regionalized systems of care at designated centers, with bypass of nearby centers of lesser or no designation. We review the evidence of the effectiveness of regionalized systems in AIS and STEMI.MethodsLiterature was searched using terms corresponding to designation of AIS and STEMI systems and from 2010 to the present. Inclusion criteria included report of an outcome on any dependent variable mentioned in the rationale for regionalization in the guidelines and an independent variable comparing care to a non‐ or pre‐regionalized system. Designation was defined in the AIS case as certification by the Joint Commission as either a primary (PSC) or comprehensive (CSC) stroke center. In the STEMI case, the search was conducted linking “regionalization” and “myocardial infarction” or citation as a model system by any American Heart Association statement.ResultsFor AIS, 17 publications met these criteria and were selected for review. In the STEMI case, four publications met these criteria; the search was therefore expanded by relaxing the criteria to include any historical or anecdotal comparison to a pre‐ or nonregionalized state. The final yield was nine papers from six systems.ConclusionAlthough regionalized care results in enhanced process and reduced unadjusted rates of disparity in access and adverse outcomes, these differences tend to become nonsignificant when adjusted for delayed presentation and hospital arrival by means other than emergency medical services. The benefits of regionalized care occur along with a temporal trend of improvement due to uptake of quality initiatives and guideline recommendations by all systems regardless of designation. Further research is justified with a randomized registry or cluster randomized design to support or refute recommendations that regionalization should be the standard of care.

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A Citywide Protocol for Primary PCI in ST-Segment Elevation Myocardial Infarction

Abstract: Guideline door-to-balloon-times were more often achieved when trained paramedics independently triaged and transported patients directly to a designated primary PCI center than when patients were referred from emergency departments.

Cited by 360 publications

References 30 publications

The impact of transferring patients with ST-segment elevation myocardial infarction to percutaneous coronary intervention-capable hospitals on clinical outcomes

The impact of transferring patients with ST-segment elevation myocardial infarction to percutaneous coronary intervention-capable hospitals on clinical outcomes

Culprit Vessel Revascularization Prior to Diagnostic Angiography as a Strategy to Reduce Delays in Primary Percutaneous Coronary Intervention

Effectiveness of regionalized systems for stroke and myocardial infarction

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