US STEMI

• The US STEMI registry assessed the association of estimated inter-hospital drive times with reperfusion strategy selection among transferred patients with STEMI in the US.
• ACTION Registry-GWTG: largest ongoing quality improvement registry of AMI in the US, capturing detailed clinical information on consecutive patients treated at participating centres.
• Between 1st July 2008 and 31st March 2012, a total of 22,481 patients eligible for PPCI or fibrinolysis were identified and transferred from 1,771 STEMI referring centres to 366 STEMI receiving centres in the registry.
• Median estimated inter-hospital drive time = 57 minutes (interquartile range [IQR], 36-88 minutes).
• With increasing estimated drive time:
  ●  Fewer patients achieved a first door-to-balloon (DTB) time within 120 minutes (marked by intersection with line)
  ●  More patients received fibrinolysis

Conclusions

In the USA, neither fibrinolysis nor PPCI is being optimally used to
achieve guideline-recommended reperfusion targets.

Pre-transfer fibrinolysis, followed by early transfer for angiography should be considered as a reperfusion option for patients unlikely to receive timely PPCI when the potential benefits of timely reperfusion outweigh bleeding risk.