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   Impact of a Rural Regional Myocardial Infarction System of Care in Wyoming  
   
نویسنده langabeer j.r. ,smith d.t. ,cardenas-turanzas m. ,leonard b.l. ,segrest w. ,krell c. ,owan t. ,eisenhauer m.d. ,gerard d.
منبع journal of the american heart association - 2016 - دوره : 5 - شماره : 5
چکیده    Background: primary percutaneous coronary intervention (pci) is the preferred reperfusion strategy for patients presenting with st-segment elevation myocardial infarction; however,to be effective,pci must be performed in a timely manner. rural regions are at a severe disadvantage,given the relatively sparse number of pci hospitals and long transport times. methods and results: we developed a standardized treatment and transfer protocol for st-segment elevation myocardial infarction in the rural state of wyoming. the study design compared the time-to-treatment outcomes during the pre- and postintervention periods. details of the program,changes in reperfusion strategies over time,and outcome improvements in treatment times were reported. from january 1,2013,to december 31,2014,889 patients were treated in 11 pci-capable hospitals (4 in wyoming,7 in adjoining states). given the large geographic distance in the state (median of 47 miles between patient and pci center),52% of all patients were transfers,and 36% were administered fibrinolysis at the referral facility. following the intervention,there was a significant shift toward greater use of primary pci as the dominant reperfusion strategy (from 47% to 60%,p=0.002),and the median total ischemic time from symptom onset to arterial reperfusion was decreased by 92 minutes (p<0.001). there was a similar significant reduction in median time from receiving center door to balloon of 11 minutes less than the baseline time (p<0.01). conclusions: rural systems of care for st-segment elevation myocardial infarction require increased levels of cooperation between emergency medical services agencies and hospitals. this study confirms that total ischemic times can be reduced through a coordinated rural statewide initiative. © 2016 the authors. published on behalf of the american heart association,inc.,by wiley blackwell.
کلیدواژه Outcomes research; Primary percutaneous coronary intervention; Quality of care; ST-segment elevation myocardial infarction; Systems of care
آدرس university of texas health science center,houston,tx, United States, university of wyoming,laramie,wy, United States, university of texas health science center,houston,tx, United States, american heart association,denver,co, United States, american heart association,denver,co, United States, south lincoln medical center,kemmerer,wy, United States, university of utah,salt lake city,ut, United States, private practice,casper,wy, United States, campbell county memorial hospital,gillette,wy, United States
 
     
   
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