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. 2012 Aug 1;5(4):555-62.
doi: 10.1161/CIRCINTERVENTIONS.112.968461. Epub 2012 Aug 7.

Transport time and care processes for patients transferred with ST-segment-elevation myocardial infarction: the reperfusion in acute myocardial infarction in Carolina emergency rooms experience

Daniel Muñoz  1 , Mayme L Roettig, Lisa Monk, Hussein Al-Khalidi, James G Jollis, Christopher B Granger
Affiliations

Transport time and care processes for patients transferred with ST-segment-elevation myocardial infarction: the reperfusion in acute myocardial infarction in Carolina emergency rooms experience

Daniel Muñoz et al. Circ Cardiovasc Interv. .

Abstract

Background: For patients with ST-segment elevation myocardial infarction transferred for primary percutaneous coronary intervention, guidelines have called for device activation within 90 minutes of initial presentation. Fewer than 20% of transferred patients are treated in such a timely fashion. We examine the association between transfer drive times and door-to-device (D2D) times in a network of North Carolina hospitals. We compare the feasibility of timely percutaneous coronary intervention using ground versus air transfer.

Methods and results: We perform a retrospective analysis of the relationship between transfer drive times and D2D times in a 119-hospital ST-segment-elevation myocardial infarction statewide network. Between July 2008 and December 2009, 1537 ST-segment-elevation myocardial infarction patients underwent interhospital transfer for reperfusion via primary percutaneous coronary intervention. For ground transfers, median D2D time was 93 minutes for drive times ≤30 minutes, 117 minutes for drive times of 31 to 45 minutes, and 121 minutes for drive times >45 minutes. For air transfers, median D2D time was 125 minutes for drive times of 31 to 45 minutes and 138 minutes for drive times >45 minutes. Helicopter transport was associated with longer door-in door-out times and, ultimately, was associated with median D2D times that exceeded guideline recommendations, no matter the transfer drive time category.

Conclusions: In a well-developed ST-segment-elevation myocardial infarction system, D2D times within 90 to 120 minutes appear most feasible for hospitals within 30-minute transfer drive time. Helicopter transport did not offer D2D time advantages for transferred STEMI patients. This finding appears to be attributable to comparably longer door-in door-out times for air transfers.

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Figures

Figure 1
Figure 1
Drive time categories for transfers for primary percutaneous coronary intervention.
Figure 2
Figure 2
Median first door to device times by drive time and transport mode.
Figure 3
Figure 3
Cumulative distribution of first door to device times by transport mode and drive time category.
Figure 4
Figure 4
Temporal anatomy of a transfer by drive time and transport mode.
Figure 5
Figure 5
Distribution of door-in door-out times by drive time and transport mode.
See this image and copyright information in PMC

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