Transport time and care processes for patients transferred with ST-segment-elevation myocardial infarction: the reperfusion in acute myocardial infarction in Carolina emergency rooms experience.

Published

Journal Article

BACKGROUND: For patients with ST-segment elevation myocardial infarction transferred for primary percutaneous coronary intervention, guidelines have called for device activation within 90 minutes of initial presentation. Fewer than 20% of transferred patients are treated in such a timely fashion. We examine the association between transfer drive times and door-to-device (D2D) times in a network of North Carolina hospitals. We compare the feasibility of timely percutaneous coronary intervention using ground versus air transfer. METHODS AND RESULTS: We perform a retrospective analysis of the relationship between transfer drive times and D2D times in a 119-hospital ST-segment-elevation myocardial infarction statewide network. Between July 2008 and December 2009, 1537 ST-segment-elevation myocardial infarction patients underwent interhospital transfer for reperfusion via primary percutaneous coronary intervention. For ground transfers, median D2D time was 93 minutes for drive times ≤30 minutes, 117 minutes for drive times of 31 to 45 minutes, and 121 minutes for drive times >45 minutes. For air transfers, median D2D time was 125 minutes for drive times of 31 to 45 minutes and 138 minutes for drive times >45 minutes. Helicopter transport was associated with longer door-in door-out times and, ultimately, was associated with median D2D times that exceeded guideline recommendations, no matter the transfer drive time category. CONCLUSIONS: In a well-developed ST-segment-elevation myocardial infarction system, D2D times within 90 to 120 minutes appear most feasible for hospitals within 30-minute transfer drive time. Helicopter transport did not offer D2D time advantages for transferred STEMI patients. This finding appears to be attributable to comparably longer door-in door-out times for air transfers.

Full Text

Duke Authors

Cited Authors

  • Muñoz, D; Roettig, ML; Monk, L; Al-Khalidi, H; Jollis, JG; Granger, CB

Published Date

  • August 1, 2012

Published In

Volume / Issue

  • 5 / 4

Start / End Page

  • 555 - 562

PubMed ID

  • 22872054

Pubmed Central ID

  • 22872054

Electronic International Standard Serial Number (EISSN)

  • 1941-7632

Digital Object Identifier (DOI)

  • 10.1161/CIRCINTERVENTIONS.112.968461

Language

  • eng

Conference Location

  • United States