Achieving the Recommendations of International Guidelines in STelevation Myocardial Infarction Patients after Start of an OffSite Percutaneous Coronary Intervention Centre and a Network Focus Group: More Attention Must be Paid to PreHospital Delay

K.A. Mol, B.M. Rahel, J.G. Meeder, B.C.A.M. van Casteren, L. Janssen, P.A. Doevendans, M.J. Cramer

Objective: Delays in the treatment of patients with ST-segment elevation myocardial infarction (STEMI) are still substantial and achieving the guideline recommendations is challenging. Specifically pre-hospital delays, including general practitioner (GP) and emergency medical transport (EMT) receive little scientific attention. Our objective is to achieve the international guideline recommendations for pre-hospital delay in STEMI patients.

Methods: This is a prospective, observational, cohort study evaluating the delays of STEMI patients. To diminish delays within the studied region an off-site percutaneous coronary intervention (PCI) centre and an acute coronary syndrome focus group comprising the Cardiology Departments, EMT service and GPs were set up. Delays before and after the start of the off-site PCI centre and focus group were analysed.

Results: The median system delay (from any first medical contact to start of PCI) significantly decreased from 80 to 65 minutes. Median electrocardiogram-to-PCI delay decreased from 64 to 48 minutes. The percentage of patients with a system delay <90 minutes improved from 73% to 85% and the percentage with an electrocardiogram-to-PCI delay <90 minutes improved from 92% to 96%. GPs play an important role within the STEMI network with 45% of the patients contacting the GP first, resulting in a slight increase in delays compared to EMT as first medical contact.

Conclusion: The guideline recommendations are achieved within the studied region after start of an off-site PCI centre and a focus group including Cardiologists, GPs and EMT service, demonstrating that focussed attention can effectively result in a decrease in pre-hospital delays