PCI is fabulous – but only if you get them to the balloon in 90 minutes or less – otherwise, we should be giving thrombolytics for STEMI. Unlike stroke, and even though many of these studies are manufacturer-supported, we have literally hundreds of thousands of patients randomized to tenecteplase, alteplase, streptokinase, etc. in combination with every different antiplatelet agent under the sun. I still don’t know whether prasugrel and lytics go together, but I’m sure we’ll have GUSTO-10,000 soon enough.
Why do I bring this up? Because it turns out we’re terrible at transferring patients to PCI-capable centers fast enough. This is a retrospective, observational study of CMS OP-3, the door-in, door-out quality measure for STEMI patients receiving transfer. A grand total of 9.7% patients in this review of 13,776 patient encounters met the quality standard of transfer within 30 minutes.
If you agree with the literature that says a DIDO time >30 minutes is associated with a 56% increased odds for in-hospital mortality, this could be important.
Lytics. Just do it.
In fact, depending on the recency of symptoms, the location of the infarct, and whether we’re off-hours for cath lab activation, I’ll give full-dose lytics on arrival while awaiting cath lab transport. Your mileage may vary, depending on your cardiology team.
“National Performance on Door-In to Door-Out Time Among Patients Transferred for Primary Percutaneous Coronary Intervention”
www.ncbi.nlm.nih.gov/pubmed/22123793