Primary percutaneous coronary intervention as a national reperfusion strategy in patients with ST-segment elevation myocardial infarction

Abstract

Background: In Denmark, primary percutaneous coronary intervention (PPCI) was chosen as a national reperfusion strategy for patients with ST-segment elevation myocardial infarction in 2003. This study describes the temporal implementation of PPCI in Western Denmark, the gradual introduction of field triage for PPCI (patients rerouted from the scene of the event directly to the invasive center), and the associated outcome.

Methods and results: The study population comprised 9514 patients treated with PPCI from 1999 to 2009 with symptom duration ≤12 hours and either a delay from the emergency medical service (EMS) call to PPCI (healthcare system delay) of ≤6 hours or as self-presenters. The median follow-up time was 3.7 years. The number of patients treated with PPCI increased from 190 in 1999 to 1212 in 2009. Among patients transported by the EMS from the scene of the event, the proportion who were field triaged directly to a PCI center increased from 33% (34/103) to 72% (616/851, P<0.001). Patients who were field triaged had lower long-term mortality, with adjusted hazard ratios (95% CI) of 1.26 (1.12-1.43) among patients transported by the EMS to a local hospital and then transferred, 1.28 (1.10-1.49) among patients self-presenting at a local hospital and then transferred, and 1.37 (1.18-1.58) among patients self-presenting at a PCI center.

Conclusions: A reperfusion strategy with PPCI only for patients with ST-segment elevation myocardial infarction was successfully implemented in Western Denmark, and the majority of patients transported by the EMS are now triaged directly to the PPCI centers. This strategy is associated with lower mortality.