Is There Any Time Left for Primary Percutaneous Coronary Intervention According to the 2007 Updated American College of Cardiology/American Heart Association ST-Segment Elevation Myocardial Infarction Guidelines and the D2B Alliance?
Christian J. Terkelsen, MD, PhD*,
Jacob T. Sørensen, MD and
Torsten T. Nielsen, MD, DMSc
Department of Cardiology B, Aarhus University Hospital, Aarhus, Denmark
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Figure 1 Typical Treatment Delays According to Reperfusion Strategy
Typical treatment delays when considering: (A) in-hospital fibrinolysis, (B) interhospital transfer for primary percutaneous coronary intervention (PPCI), (C) pre-hospital rerouting to the catheterization laboratory at a high-volume percutaneous coronary intervention (PCI) center, and (D) admission at a local low-volume PCI center. For the various "PCI-related delays," the acceptable transport time is presented for patients rerouted to a PCI center pre-hospital. ACC/AHA STEMI Guidelines = American College of Cardiology/American Heart Association ST-Segment Elevation Myocardial Infarction Guidelines; EMS = Emergency Medical Services.
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Figure 2 ORs for 30-Day Death in Patients Randomized to PPCI Compared With Fibrinolysis
Odds ratio (OR) and 95% confidence interval (CI) for 30-day death in patients randomized to primary percutaneous coronary intervention (PPCI) when compared with fibrinolysis (FL) according to presentation delay (left) and PCI-related delay (extra delay used to perform PPCI instead of initiating fibrinolysis) (right). Odds ratios were adjusted for patient-, hospital-, and study-level covariates. From Boersma et al. (7).
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