Abstract P102: Characteristics of Practice of Primary Angioplasty in Quebec, Canada (2008-2009): A Systematic Field Evaluation

Background: Primary angioplasty (PPCI) is the predominant reperfusion therapy for ST-elevation myocardial infarction (STEMI) in Quebec where there are 13 PPCI centers. Our systematic province-wide field evaluation examined contemporary practice of PPCI such as arterial access site and use of stents and thrombus aspiration devices. Methods: The 82 hospitals that treat over 95% of all acute myocardial infarctions occurring annually in Quebec participated in a systematic evaluation in 2008-9. Designated medical record librarians abstracted data from medical charts of patients with a final diagnosis of myocardial infarction who presented to an emergency room with characteristic symptoms. STEMI was confirmed by ECG interpretation. Results: Of 1876 treated STEMI patients, 1505 (80%) were sent for PPCI with 594 (39%) presenting directly to a PPCI center and 911 (61%) transferred from a non PPCI-capable center. Of these, 1334 patients (88 %) underwent PPCI. Almost all (1265/1334; 95%) had stent insertion (12% were drug-eluting stents). The radial approach was used in 844 (63%) patients with a median 12 min (6-21; all ranges 10-90 percentile) from first arterial puncture to first device. Patients with a femoral approach had a similar median delay [11 min (6-25)]. Door-to-balloon times were similar: 98 min (55-203) for the radial approach and 101 min (50-207) for the femoral approach. The first reperfusion device was a balloon in 687 patients (52%), a thrombus aspiration device in 485 patients (37%), and a direct stent in 145 patients (11%). Median delays from first puncture to first device were 13 min (7-26) for balloon, 10 min (6-18) for thrombus aspiration device, and 12 min (6-25) for direct stent deployment. There was substantial variation in radial versus femoral approach and type of first device by PPCI center. Conclusion: This contemporary evaluation of a complete system of STEMI care shows that most PPCI is performed in patients transferred from another hospital. The radial approach now predominates. The most frequent first reperfusion device is still the balloon but a substantial proportion of patients undergo thrombus aspiration. Drug eluting stent use was infrequent. Treatment delays did not vary by either arterial access site or type of first device.