November 28th, 2011
Long Transfer Delays for STEMI Patients at Most Hospitals Without Primary PCI
Larry Husten, PHD
Fewer than 10% of STEMI patients eligible for PCI who arrive at a hospital without PCI capability are transferred within the recommended times, according to a new study published in the Archives of Internal Medicine. Although dramatic improvements in door-to-balloon times have been achieved in recent years in PCI-capable hospitals, the new report suggests that hospitals without PCI capability are failing to achieve a door-in to door-out (DIDO) time with 30 minutes.
Jeph Herrin and colleagues (including senior author Harlan Krumholz, editor-in-chief of CardioExchange) analyzed CMS data on 13,776 STEMI patients who were transferred to another hospital for PCI. The median DIDO time was 64 minutes. Only 9.7% were transferred within 30 minutes, and 31% were transferred after more than 90 minutes. Women, non-white patients, older patients, and patients with a contraindication to fibrinolytic therapy had significantly longer DIDO times.
The authors write that their results “suggest that many patients may have benefitted from fibrinolytic therapy at the transferring hospital rather than from transfer for primary PCI.”
An accompanying research letter by Eric Secemsky and colleagues reports on the experience of a large public hospital (San Francisco General Hospital), in which door-to-balloon times were significantly reduced when the hospital created an on-site 24-hour PCI facility.
In an accompanying editorial, Rita Redberg writes that there are “immovable obstacles to shortening” the DIDO time to 30 minutes and that “it is time to consider other strategies.” When possible, she writes, thrombolytic therapy should be administered in the ambulance to patients who cannot be taken immediately to a primary PCI facility. Patients should be transferred only if they are at “high risk and there is reason to believe” that the patient can receive primary PCI within 60 minutes.