09 Dec Distance To Hospital Prevents Timely PCI and Lytic Therapy For Many Patients
Medical Research: What is the background for this study? What are the main findings?
Response: Current guidelines recommend timely reperfusion in patients presenting with ST-elevation myocardial infarction, with primary PCI being the preferred method if delivered in an expedient fashion. Otherwise, guidelines recommend that eligible patients should be treated with fibrinolysis prior to transfer to a PCI capable hospital. In our study, we used Google Maps to estimate drive times between the initial presenting hospital and the PCI-capable hospital looked at the association between estimated drive time and reperfusion strategy (primary PCI or fibrinolysis) selection.
We found that less than half of eligible patients with an estimated drive time of more than 30 minutes received primary PCI in time, and only half of patients with more than an hour’s drive received lytics before transfer. This suggests that neither primary PCI nor pre-transfer fibrinolytic therapy is being used optimally. Among eligible patients with a drive time of 30-120 minutes, we found no significant mortality difference but higher bleeding risk among patients receiving lytics prior to transfer; this increased bleeding risk was focused in patients that required rescue PCI.
Medical Research: What should clinicians and patients take away from your report?
Response: Our analysis suggests that neither primary PCI nor fibrinolysis is used properly among patients requiring interhospital transfer. If the estimated drive is greater than 30-45 minutes, transferring physicians should consider giving lytics prior to early transfer in eligible patients, providing that the benefits outweigh the bleeding risks.
Medical Research: What recommendations do you have for future research as a result of this study?
Response: Future research should be directed toward optimizing reperfusion strategy selection among STEMI patients presenting to a local hospital requiring transfer. Our study suggests that even a simple tool such as Google Maps can be helping in deciding whether to aim for primary PCI or whether to consider lytic therapy prior to transfer.