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Going Straight to PCI for Patients With STEMI

Going Straight to PCI for Patients With STEMI

Research indicates that mortality and morbidity can be reduced in patients with STEMI when they have faster times to reperfusion. Guidelines from the American College of Cardiology (ACC) and American Heart Association (AHA) recommend that PCI devices be activated within 90 minutes of first medical contact in this patient group. Although the adoption of various strategies has led to significant improvements in national reperfusion metrics, research suggests that the ACC/AHA guideline-recommended goals have yet to be systematically achieved. Other studies indicate that delays with triage and ED evaluation may contribute to the inability to achieve timely reperfusion. Adopting a New Approach As an interventional cardiologist in Canada, Akshay Bagai, MD, MHS, worked in a hospital cath lab where patients with pre-hospital electrocardiograms (ECGs) showing that they had STEMI were routinely brought directly to the lab by emergency medical services (EMS). “We found that we were saving time by bypassing the ED,” he explains. When Dr. Bagai learned that this practice was not endorsed in the United States, he and his colleagues sought to study the approach further. In an analysis published in Circulation: Cardiovascular Interventions, Dr. Bagai and colleagues reviewed data from the Reperfusion of Acute Myocardial Infarction in Carolina Emergency Departments (RACE) project, a program among North Carolina hospitals that collaborated to develop a coordinated, regional system to care for STEMI patients. From 21 of these hospitals, they studied 1,687 patients with pre-hospital STEMI who had been transported via EMS for primary PCI and were either evaluated in the ED or taken directly to the cath lab. Key Findings The median time from first medical contact to reperfusion...
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