Treatment Delays Identified in Regional STEMI Systems

Delays most frequently occur at referral hospital, PCI center, and during transport process

TUESDAY, Sept. 20 (HealthDay News) -- Treatment delays occur in standardized regional systems for transfer of patients with ST-segment-elevation myocardial infarction (STEMI) to receive primary percutaneous coronary intervention (PCI), with delays most frequently occurring at the referral hospital, PCI center, and during the transport process, according to a study published online Sept. 19 in Circulation.

Michael D. Miedema, M.D., from the Abbott Northwestern Hospital in Minneapolis, and colleagues investigated the frequency, magnitude, and clinical impact of specific delays in the rapid transfer of patients with STEMI for primary PCI. A total of 2,034 patients with STEMI transferred for PCI in a standardized regional STEMI system were observed from March 2003 to December 2009.

The investigators found that in spite of long-distance transfers, 30.4 of patients received treatment within 90 minutes or less, and 65.7 percent in 120 minutes or less. Delays occurred most frequently at the referral hospital, attributed to awaiting transport and emergency department delays, followed by delays at PCI centers, and transport. In the referral hospital, delays were most commonly attributed to awaiting transport and emergency department delays. Delays of the greatest magnitude were due to diagnostic dilemmas and non-diagnostic initial electrocardiograms (ECGs). Contrary to non-diagnostic initial ECGs, which had no effect on mortality, delays caused by cardiac arrest and cardiogenic shock were associated with the highest in-hospital mortality. Transport and PCI center segments showed a significant variation in both the magnitude and clinical impact of delays.

"Our data indicate that clinical outcomes vary significantly according to the reason for the delay, and that not all delays are STEMI system dependent," the authors write.

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