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

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).3Articles 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.4It 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 care and organizing quality improvement initiatives to decrease time to treatment and increase adherence to evidence-based therapies for patients with STEMI.5,6 In this issue of Circulation , 2 pioneering model regional approaches that use integrated systems of care to increase the number of STEMI patients with …