Abstract 12612: Characteristics of Best Practice Primary PCI Timing for STEMI Transfer Patients: Findings From the AHA Mission: Lifeline Program®

Background: Current guidelines recommend primary PCI for STEMI transfer patients if the estimated time-to-device is within 120 minutes of initial presentation. We determined the hospital-level and patient-level characteristics of Best Practice Primary PCI Timing (BPT: initial door-to-device 120 minutes) for STEMI transfer patients. Methods: We studied 14,518 STEMI eligible transfer patients from 398 AHA Mission: Lifeline® hospitals referred for primary PCI between July, 2008 and December, 2012. Patients with cardiogenic shock, cardiac arrest, and estimated transfer times > 60 minutes (by Google Maps driving times) were excluded from this analysis , the latter to focus on non-travel-related characteristics of treatment delay. Patients achieving BPT vs DPT were compared. Results: The median estimated transfer distance was 26.5 miles. BPT was achieved in nearly two-thirds of patients (N=9,380, 65%). While there were small increases in estimated travel time for patients with DPT compared with OPT, the Door-In Door-Out (DIDO) time was more than doubled in the DPT group (Table). DPT was associated with older age, female sex, diabetes mellitus, prior CABG, and heart failure on presentation. Air transport, PCI hospital MI volume, academic status, off hour presentation and PCI hospital size were not associated with BPT. Conclusions: Approximately two-thirds of hemodynamically stable STEMI transfer patients can achieve BPT if located within 60-minute drive time from a primary PCI hospital. Patients with DPT appear to be more complicated on presentation and have markedly longer DIDO times. Increased emphasis on reducing DIDO times is critical for achieving BPT.