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Background  Patients with ST‐elevation myocardial infarction ( STEMI ) with out‐of‐hospital cardiac arrest ( OHCA ) may benefit from direct transport to a percutaneous cardiac intervention (PCI) hospital but have previously been less likely to bypass local non‐ PCI  hospitals to go to a  PCI  center.    Methods and Results  We reported time trends in emergency medical service transport and care of patients with  STEMI  with and without  OHCA  included from 171  PCI ‐capable hospitals in 16  US  regions with participation in the Mission: Lifeline  STEMI  Accelerator program between July 1, 2012, and March 31, 2014. Time trends by quarter were assessed using logistic regression with generalized estimating equations to account for hospital clustering. Of 13 189 emergency medical service–transported patients, 88.7% (N=11 703; 10.5%  OHCA ) were taken directly to  PCI  hospitals. Among 1486 transfer‐in patients, 21.7% had  OHCA . Direct transport to a  PCI  center for  OHCA  increased from 74.7% (July 1, 2012) to 83.6% (March 31, 2014) (odds ratio per quarter, 1.07; 95% confidence interval, 1.02–1.14), versus 89.0% to 91.0% for patients without  OHCA  (odds ratio, 1.03; 95% confidence interval, 0.99–1.07; interaction  P =0.23). The proportion with prehospital  ECG s increased for patients taken directly to  PCI  centers (53.9%–61.9% for those with  OHCA  versus 73.9%–81.9% for those without  OHCA ; interaction  P =0.12). Of 997 patients with OHCA taken directly to  PCI  hospitals and treated with primary  PCI , first medical contact‐to‐device times within the guideline‐recommended goal of ≤90 minutes were met for 34.5% on July 1, 2012, versus 41.8% on March 31, 2014 (51.6% and 56.1%, respectively, for 9352 counterparts without OHCA; interaction  P =0.72).    Conclusions  Direct transport to  PCI  hospitals increased for patients with STEMI with and without  OHCA  during the 2012 to 2014 Mission: Lifeline  STEMI  Accelerator program. Proportions with prehospital  ECG s and timely reperfusion increased for patients taken directly to  PCI  hospitals.

journal of the american heart association

Improvement in Care and Outcomes for Emergency Medical Service–Transported Patients With  ST ‐Elevation Myocardial Infarction (STEMI) With and Without Prehospital Cardiac Arrest: A Mission: Lifeline  STEMI  Accelerator Study