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A citywide protocol for primary PCI in ST-segment elevation myocardial infarction.
N Engl J Med. 2008 Jan 17; 358(3):231-40.NEJM

Abstract

BACKGROUND

If primary percutaneous coronary intervention (PCI) is performed promptly, the procedure is superior to fibrinolysis in restoring flow to the infarct-related artery in patients with ST-segment elevation myocardial infarction. The benchmark for a timely PCI intervention has become a door-to-balloon time of less than 90 minutes. Whether regional strategies can be developed to achieve this goal is uncertain.

METHODS

We developed an integrated-metropolitan-area approach in which all patients with ST-segment elevation myocardial infarction were referred to a specialized center for primary PCI. We sought to determine whether there was a difference in door-to-balloon times between patients who were referred directly from the field by paramedics trained in the interpretation of electrocardiograms and patients who were referred by emergency department physicians.

RESULTS

Between May 1, 2005, and April 30, 2006, a total of 344 consecutive patients with ST-segment elevation myocardial infarction were referred for primary PCI: 135 directly from the field and 209 from emergency departments. Primary PCI was performed in 93.6% of patients. The median door-to-balloon time was shorter in patients referred from the field (69 minutes; interquartile range, 43 to 87) than in patients needing interhospital transfer (123 minutes; interquartile range, 101 to 153; P<0.001). Door-to-balloon times of less than 90 minutes were achieved in 79.7% of patients who were transferred from the field and in 11.9% of those transferred from emergency departments (P<0.001).

CONCLUSIONS

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.

Authors+Show Affiliations

University of Ottawa Heart Institute, Ottawa, ON, Canada. mlemay@ottawaheart.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

18199862

Citation

Le May, Michel R., et al. "A Citywide Protocol for Primary PCI in ST-segment Elevation Myocardial Infarction." The New England Journal of Medicine, vol. 358, no. 3, 2008, pp. 231-40.
Le May MR, So DY, Dionne R, et al. A citywide protocol for primary PCI in ST-segment elevation myocardial infarction. N Engl J Med. 2008;358(3):231-40.
Le May, M. R., So, D. Y., Dionne, R., Glover, C. A., Froeschl, M. P., Wells, G. A., Davies, R. F., Sherrard, H. L., Maloney, J., Marquis, J. F., O'Brien, E. R., Trickett, J., Poirier, P., Ryan, S. C., Ha, A., Joseph, P. G., & Labinaz, M. (2008). A citywide protocol for primary PCI in ST-segment elevation myocardial infarction. The New England Journal of Medicine, 358(3), 231-40. https://doi.org/10.1056/NEJMoa073102
Le May MR, et al. A Citywide Protocol for Primary PCI in ST-segment Elevation Myocardial Infarction. N Engl J Med. 2008 Jan 17;358(3):231-40. PubMed PMID: 18199862.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A citywide protocol for primary PCI in ST-segment elevation myocardial infarction. AU - Le May,Michel R, AU - So,Derek Y, AU - Dionne,Richard, AU - Glover,Chris A, AU - Froeschl,Michael P V, AU - Wells,George A, AU - Davies,Richard F, AU - Sherrard,Heather L, AU - Maloney,Justin, AU - Marquis,Jean-François, AU - O'Brien,Edward R, AU - Trickett,John, AU - Poirier,Pierre, AU - Ryan,Sheila C, AU - Ha,Andrew, AU - Joseph,Phil G, AU - Labinaz,Marino, PY - 2008/1/18/pubmed PY - 2008/1/30/medline PY - 2008/1/18/entrez SP - 231 EP - 40 JF - The New England journal of medicine JO - N Engl J Med VL - 358 IS - 3 N2 - BACKGROUND: If primary percutaneous coronary intervention (PCI) is performed promptly, the procedure is superior to fibrinolysis in restoring flow to the infarct-related artery in patients with ST-segment elevation myocardial infarction. The benchmark for a timely PCI intervention has become a door-to-balloon time of less than 90 minutes. Whether regional strategies can be developed to achieve this goal is uncertain. METHODS: We developed an integrated-metropolitan-area approach in which all patients with ST-segment elevation myocardial infarction were referred to a specialized center for primary PCI. We sought to determine whether there was a difference in door-to-balloon times between patients who were referred directly from the field by paramedics trained in the interpretation of electrocardiograms and patients who were referred by emergency department physicians. RESULTS: Between May 1, 2005, and April 30, 2006, a total of 344 consecutive patients with ST-segment elevation myocardial infarction were referred for primary PCI: 135 directly from the field and 209 from emergency departments. Primary PCI was performed in 93.6% of patients. The median door-to-balloon time was shorter in patients referred from the field (69 minutes; interquartile range, 43 to 87) than in patients needing interhospital transfer (123 minutes; interquartile range, 101 to 153; P<0.001). Door-to-balloon times of less than 90 minutes were achieved in 79.7% of patients who were transferred from the field and in 11.9% of those transferred from emergency departments (P<0.001). CONCLUSIONS: 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. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/18199862/A_citywide_protocol_for_primary_PCI_in_ST_segment_elevation_myocardial_infarction_ L2 - https://www.nejm.org/doi/10.1056/NEJMoa073102?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -