(February 12, 2010 - Insidermedicine)

About two-thirds of Canadians live within a 60 minute drive of a facility that can provide percutaneous coronary intervention (PCI), the current treatment of choice for ST-segment elevation myocardial infarction (STEMI), according to research published in the latest issue of Open Medicine.

Here are some recommendations regarding prehospital destination protocols for STEMI patients from the American Heart Association and American College of Cardiology:

•    Patients with STEMI who have cardiogenic shock and are less than 75 years of age should be brought immediately or secondarily transferred to facilities capable of cardiac catheterization and rapid revascularization if it can be performed within 18 hours of onset of shock.

•    Patients with STEMI who have contraindications to fibrinolytic therapy should be brought immediately or secondarily transferred promptly (i.e., primary receiving hospital door-to-departure time less than 30 minutes) to facilities capable of cardiac catheterization and rapid revascularization

•    Every community should have a written protocol that guides emergency system personnel in determining where to take patients with suspected or confirmed STEMI.

Researchers out of the University of Calgary used geographical information systems to estimate the amount of travel time by ground transportation to PCI facilities. They then used  2006 Canadian census data to identify adults aged 40 and older who lived within  60, 90, and 120 minutes of such a facility.

Overall, 63.9% of Canadians aged 40 and older live within 60 minutes of a PCI facility, although this proportion varies widely from province to province. In New Brunswick for example, the proportion is only 15.8%. Adding of a single facility to each of 4 selected provinces would increase this proportion by 3.2 to 4.3%, depending on the province, providing ready access to PCI to about 470,000 additional individuals.

Today's research provides information that can help decision-makers plan the development of regional STEMI care models.