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(Circulation. 2007;116:689-692.)
© 2007 American Heart Association, Inc.

Editorial

Regional Systems of Care for Patients With ST-Elevation Myocardial Infarction

Being at the Right Place at the Right Time

From the Department of Medicine, Boston University School of Medicine, Boston, Mass.

Correspondence to Dr Alice K. Jacobs, Section of Cardiology, Boston Medical Center, 88 East Newton St, Boston, MA 02118. E-mail alice.jacobs@bmc.org

Key Words: Editorials • angioplasty • myocardial infarction

An extract of the first 250 words of the full text is provided, because this article has no abstract.

ST-segment–elevation myocardial infarction (STEMI) presents a true medical emergency, where the relationship between treatment (reperfusion) and mortality is measured in minutes. Fortunately, when administered early in properly selected patients, both fibrinolytic therapy and primary percutaneous coronary intervention (PCI) have been associated with significant reductions in mortality.^1,2 Unfortunately, it has become increasingly clear that only a minority of STEMI patients receive fibrinolytic therapy within 30 minutes from door-to-needle or receive primary PCI within 90 minutes from door-to-balloon as recommended by the guidelines from the American College of Cardiology/American Heart Association (AHA).³

Articles pp 721 and 729

Moreover, as enthusiasm for primary PCI as the preferred reperfusion modality has escalated, the importance of time to treatment has gained increased recognition. Door-to-balloon time is now included as 1 of the core quality measures collected and reported by the Centers for Medicare and Medicaid and The Joint Commission. Furthermore, although the performance of primary PCI has increased from 18% to 53% worldwide during the past 7 years (with an expected decrease in use of fibrinolytic therapy from 50% to 28%), nearly 30% of patients still do not receive either form of therapy even in the absence of contraindications.⁴

It is these realities of the current status of reperfusion therapy that have fostered the concept of systems and centers of care for STEMI patients and interest in the exploration of the feasibility of establishment of regional STEMI networks. It is not surprising that healthcare systems and hospitals across the country are examining their standards of . . . [Full Text of this Article]

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