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Primary percutaneous intervention (PPCI) is the treatment of choice for ST segment elevation myocardial infarction (STEMI). Despite a reduction of D2BTs at PPCI centers using a variety of prehospital and interhospital strategies, D2BTs remain prolonged amongst patients requiring inter-facility transport for PPCI. The Vancouver Coastal Health Authority (VCHA) “Hot STEMI” inter-facility transfer protocol was implemented on May 3, 2011. It was designed to enable the remote activation of cardiac catheterization teams and timely transfer of STEMI patients from community hospitals to a PPCI center using a single phone call. We describe the impact of this transfer protocol on D2BTs for PPCI within the VCHA.
All cases of STEMI who were transferred for PPCI from one of 4 community hospitals to one of 2 PPCI capable hospitals within the VCHA between May 2010 and May 2012 were included in this study. The primary endpoint was the comparison of median D2BTs of transferred patients that received PPCI 1 year before and 1 year after the implementation of the “Hot STEMI” transfer protocol.
Baseline clinical characteristics were similar between groups. In the year prior to protocol implementation, there were 53 STEMI cases transferred for PPCI (median D2BT: 132.5 min). Following implementation, there were 77 STEMI cases transferred for PPCI (median D2BT: 115 min), demonstrating a 17.5 minute overall reduction (p=0.007). Two of the four community hospitals that treated very few STEMI patients showed increases in D2BT post-protocol. Overall in-hospital mortality in the pre-protocol group was 7.5%, compared to 5.2% in the post-protocol group (p=0.71); median length of stay was 3 days for both groups.
Use of the VCHA ‘Hot STEMI’ protocol reduced overall D2BT for STEMI requiring inter-hospital transfer in the region by 17.5 minutes. However, significant variability existed in D2BT within individual hospitals prior to and following implementation of this protocol. This suggests more work is needed to further reduce inter-facility transfer times for PPCI, especially in facilities that treat small numbers of patients.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: AMI and PCI
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 1158-106
- 2013 American College of Cardiology Foundation