Pre-hospital Transport Times and Outcomes After Different Reperfusion Strategies for ST-Elevation Myocardial Infarction

This study evaluated prehospital transport times and clinical outcomes after different reperfusion strategies for ST-elevation myocardial infarction in a real-world setting. We consecutively enrolled 27,205 patients who underwent percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction in Michigan from 2010 to 2016. Primary PCI was performed in 25,927 patients (95%), whereas 1,278 (5%) were treated with a pharmacoinvasive strategy. The overall use of a pharmacoinvasive strategy decreased during the study period (p <0.001). Prehospital transport times were estimated by using the Google Maps API from the centroid of each home zip code tabulation area to the zip code tabulation area for the nearest hospital with PCI capability. The estimated prehospital transport time predicted the choice of reperfusion strategy (p <0.001). Primary PCI was used in 97% of the patients living within 1 hour from a hospital with PCI capability compared with 48% with estimated transport times >1 hour. Bleeding and mortality rates were similar for patients treated with primary PCI or a pharmacoinvasive strategy (odds ratio 0.832, 95% confidence interval 0.649 to 1.067, p = 0.147). In conclusion, almost all patients in Michigan had timely access to a hospital with PCI capability and received treatment with primary PCI. The authors declare no conflicts of interests.