Abstract 243: Regional System to Optimize First Medical Contact to Balloon times for Primary PCI in STEMI Penalized by New AHA Guidelines

INTRO: The AHA Mission Lifeline recommends an EMS first medical contact (FMC) to balloon time of 90 minutes for patients STEMI when presenting directly to a percutaneous coronary intervention (PCI) hospital but 120 minutes for those requiring transfer from a non-PCI hospital. We examine the impact of direct air medical transport from the scene to a PCI center of rural patients without access to a local PCI capable hospital versus EMS transport to and subsequent transfer from a non-PCI hospital. METHODS: A regional STEMI transport system was developed in 2012 for western Pennsylvania between non-PCI capable hospitals, local EMS agencies, and UPMC Presbyterian Hospital. This system was designed to improve transfer times and one component of this was to allow local EMS companies to activate the cath lab directly. In this program, an emergency helicopter meets the EMS and allows for direct transport of the patient to PCI hospital, bypassing the local ED. We compared reperfusion times in consecutive patients brought directly to the PCI center versus patients taken by EMS to a local ED first in 2012-2013. Patients were then matched based on distance from PCI center. RESULTS: A total of 22 patients were brought directly to the PCI center and 32 patients were taken by local EMS to their local non-PCI hospital followed by helicopter transport for primary PCI. Median FMC to balloon times for patients taken directly from the scene to PCI center was 22 minutes less (113 vs 135 minutes, p=0.0006) than when first taken to a local ED. There was no difference in PCI arrival to balloon times (26 vs 20 minutes, p=0.128) and breakdown of median times listed in table 1. The average linear flight distance between groups was 37 vs 41 miles (p=0.2123). CONCLUSIONS: In this regional system, transport of rural patients with STEMI directly to a PCI center improves FMC to balloon times when compared to patients taken to a local non-PCI hospital first. Despite shortening reperfusion times with implementation of this system, some of these patients would fall out of the recommended AHA guidelines because they are considered to present directly to the PCI hospital. Further investigation on the benefits of direct transport of rural patients to a PCI center is warranted and whether the AHA recommended FMC to balloon time needs adjustment in this scenario. ![][1] [1]: /embed/graphic-1.gif