Impact of a Rural Regional Myocardial Infarction System of Care in Wyoming

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.