STEMI patients receive faster care in states that allow direct EMS transport to specialized hospitals

New research suggests people exhibiting ST-segment elevation myocardial infarction (STEMI) receive life-saving treatment more quickly if they live in states that allow emergency medical services (EMS) to take patients straight to hospitals that offer specialized treatment, rather than those that do not.

“Every year, more than 750,000 Americans suffer a myocardial infarction, and 30 percent of these are STEMI,” wrote lead author Jacqueline L. Green, MD, MPH, of the University of Michigan in Ann Arbor, and colleagues, in a study published May 1 in the American Heart Association’s journal Circulation. “The time from first medical contact to treatment in STEMI is a critical determinant of patient outcomes. Emergency medical services (EMS) systems that can take patients directly to a hospital capable of performing immediate percutaneous coronary intervention (PCI) may dramatically shorten delays by bypassing other hospitals that do not provide such services.”

The study cohort included 19,287 patients treated at 379 hospitals in 12 states in 2013 and 2014. The researchers assessed the time to treatment for myocardial infarction in six states with bypass policies to six states without such policies.

In states with bypass policies—Delaware, Iowa, Maryland, Massachusetts, North Carolina and Pennsylvania—57 percent of people exhibiting myocardial infarction received PCI in 90 minutes or less and 82 percent underwent PCI within 120 minutes of first medical contact.

In states with no bypass policies—Connecticut, New York, Minnesota, South Carolina, Texas and Virginia—only 45 percent of people received PCI within 90 minutes and 77 percent within 120 minutes.

Patients living in states with bypass policies were approximately 75 percent more likely to receive a diagnostic electrocardiogram (ECG). Patients living in states with no bypass policies had only a 69 percent chance of receiving an ECG.

The researchers also noted 27 percent of patients delayed their access to an EMS or took themselves to the hospital.

“The present analysis demonstrates that allowing EMS providers to bypass non-PCI-capable hospitals in favor of PCI-capable hospitals can significantly reduce time to appropriate reperfusion therapy,” wrote Daniel Kolansky, MD and Paul Fiorilli, MD, from the University of Pennsylvania, in an accompanying editorial.

Kolansky and Fiorilli said there are other areas for improvement in STEMI care, including the routine use of pre-hospital ECGs, community educational programs and regional systems of care for STEMI patients to reduce the time from EMS to PCI treatment.

“Although much work has already been accomplished to expedite the care of these patients, we need to continue to put together all the pieces of this puzzle to provide the best possible heart attack care for our patients,” they wrote.