A new study claims that despite improvements in treating ST-Segment-Elevation Myocardial Infarction (STEMI) heart attack patients needing emergency angioplasty procedures, delays still occur, particularly during transfer to hospitals that can perform the procedure.

Researchers at the Minneapolis Heart Institute Foundation (MHIF; MN, USA) conducted a prospective, observational study between March 2003 and December 2009, involving 2,034 patients transferred for primary percutaneous coronary intervention (PCI) as part of a regional STEMI treatment system. Despite long-distance transfers, 30.4% of patients were treated in less than 90 minutes, and 65.7% were treated in less than 120 minutes. Delays occurred most frequently at the referral hospital (64.0%), followed by the PCI center (15.7%), and transport (12.6%). For the referral hospital, the most common reasons for delay were awaiting transport (26.4%) and emergency department delays (14.3%).

Diagnostic dilemmas and nondiagnostic initial electrocardiograms (ECGs) led to delays of the greatest magnitude. Delays caused by cardiac arrest and/or cardiogenic shock had the highest in-hospital mortality (30.6%), in contrast with nondiagnostic initial ECGs, which, despite long treatment delays, did not affect mortality. Significant variation in both the magnitude and clinical impact of delays also occurred during the transport and PCI center segments. The study was published in the September 19, 2011, issue of Circulation.

“Our ultimate goal is to improve timely access to angioplasty in patients with STEMI,” said senior author Timothy Henry, MD, director of research at the MHIF. “We've been very successful doing this in hospitals that are equipped to provide the procedure. This study emphasizes that now our focus should be on regional systems which seek to incorporate those hospitals that require patient transfer in the process.”

"A study recently published found that more than twice as many people are getting treatment within 90 minutes of arriving at an angioplasty hospital than were five years ago, so we are making great progress," added Professor Chris Granger, MD, director of the Cardiac Care Unit at Duke University Medical Center (Durham, NC, USA). “But Dr. Henry's study shows us that many patients still have delays, and that certain types of delays are associated with worse outcomes. So there is an important opportunity to further improve care, especially for patients being transferred from hospitals not equipped to do angioplasty.”

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