Statewide Coordinated STEMI Approach Deemed Successful

Drop in rate of not receiving perfusion; improved treatment times for hospital transfer patients

MONDAY, June 4 (HealthDay News) -- A statewide coordinated effort across hospitals and emergency medical service (EMS) providers to transport patients with ST-segment elevation myocardial infarction (STEMI) to hospitals providing percutaneous coronary intervention (PCI) has resulted in improved outcomes, according to a study published online June 4 in Circulation.

James G. Jollis, M.D., from Duke University in Durham, N.C., and colleagues analyzed performance data from the 119 North Carolina hospitals participating in a coordinated plan to treat STEMI patients according to presentation.

The researchers found that, between July 2008 and December 2009, 6,841 patients with STEMI were treated (median age, 59 years; 30 percent women). Of the treated patients, 3,907 presented directly to 21 PCI hospitals and 2,933 were transferred from a total of 98 non-PCI hospitals. Over the period analyzed, the rate of patients not receiving reperfusion decreased significantly from 5.4 to 4.0 percent. Treatment times improved substantially for patients requiring hospital transfer. For patients presenting directly to PCI hospitals, the median door-to-device times declined significantly, from 64 to 59 minutes, with EMS-transported patients the most likely to reach door-to-device treatment goals within 90 minutes (91 percent). Mortality was significantly lower for patients treated within guideline goals (2.2 percent, versus 5.7 percent for those exceeding guideline recommendations).

"By extending regional coordination to an entire state, rapid diagnosis and treatment of STEMI has become an established standard of care independent of health care setting or geographic location," the authors write.

Several authors disclosed financial ties to medical device and pharmaceutical companies, including Phillips, Sanofi-Aventis, and the Medtronic Foundation, all of which funded the study.

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