STEMI: Hospital destination policies improve time to first medical contact

Time from first medical contact to treatment is a “critical determinant” of outcomes in patients with STEMI, Dr. Green and her colleagues wrote in their report.

“When a patient initially is taken to a non–PCI-capable hospital, considerable treatment delays are introduced as the patient must be evaluated, triaged, and wait for a second EMS transport to be called, arrive, and take the patient from the initial hospital to the PCI hospital,” they wrote.

However, whether reducing total ischemic time by “a few minutes” has clinical significance remains controversial, they acknowledged.

They noted that in one previous study, annual improvements in door-to-balloon times of about 16 minutes was not associated with significant reductions in mortality at the population level; however, a reanalysis of that data showed that effects at the individual lever were “important, even if modest at the population level,” they wrote.