Jacqueline L. Green
Patients with STEMI in states with laws allowing emergency medical services to bypass non-PCI-capable hospitals were treated faster than those in states without such laws, according to a report from the American Heart Association Mission: Lifeline Program.
Jacqueline L. Green, MD, MPH, cardiologist at Piedmont Heart Institute in Fayetteville, Georgia, and colleagues analyzed 19,827 patients hospitalized for STEMI in 2013 and 2014 and listed in the National Cardiovascular Data Registry and Acute Coronary Treatment and Intervention Outcomes Network Registry.
The researchers compared patients from six states with bypass policies — Delaware, Iowa, Maryland, Massachusetts, North Carolina and Pennsylvania — with patients from six states without bypass policies — Connecticut, Minnesota, New York, South Carolina, Texas and Virginia. The states were matched based on region, hospital density and percent state participation in the registry. The patients were matched based on age, sex and comorbidities.
Outcomes of interest were reperfusion and receipt of timely PCI.
After adjustments, 57.9% of patients from the states with bypass policies received primary PCI within their relevant guideline-recommended time from first medical contact (95% CI, 53.2-63.5) compared with 47.5% of patients from states without bypass policies (95% CI, 43.4-51.7), Green and colleagues reported.
The time advantage was significant at 90 minutes (OR = 1.59; 95% CI, 1.19-2.12) and 120 minutes (OR = 1.44; 95% CI, 1.06-1.95) from first medical contact, according to the researchers.
There was a trend toward patients from the states with bypass policies being more likely to receive any reperfusion therapy (OR = 1.77; 95% CI, 0.96-3.24), Green and colleagues wrote.
“Our findings provide a compelling case for state-level policies that allow emergency medical services to take patients directly to the PCI-capable centers,” Green said in a press release. “A policy that improves access to timely care for even an additional 10% of patients could have a significant impact on a population level.”
In a related editorial, Paul N. Fiorilli, MD, and Daniel M. Kolansky, MD, both from the division of cardiovascular medicine at the Hospital of the University of Pennsylvania, wrote: “The care and outcomes of STEMI patients can be improved without increasing the number of PCI-capable hospitals. The results indicate that simply living in a state which has a statewide pre-hospital plan for EMS transport is associated with improved treatment times for heart attack patients. This improvement is certainly statistically significant, although the absolute magnitude of the improvement in terms of actual minutes saved from [first medical contact] to reperfusion is modest.” – by Erik Swain
Disclosures: Green, Fiorilli and Kolansky report no relevant financial disclosures. One author reports he serves as medical director for Zoll Medical.