Expansion of off-site percutaneous coronary intervention centres significantly reduces ambulance driving time to primary
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Neth Heart J https://doi.org/10.1007/s12471-020-01466-2
Expansion of off-site percutaneous coronary intervention centres significantly reduces ambulance driving time to primary PCI in the Netherlands N. P. G. Hoedemaker · R. J. de Winter · G. J. Kommer · H. Giesbers · R. Adams · S. E. van den Bosch · P. Damman
© The Author(s) 2020
Abstract Introduction In patients with ST-elevation myocardial infarction (STEMI), percutaneous coronary intervention (PCI)-mediated reperfusion is preferred over pharmacoinvasive reperfusion with fibrinolysis if transfer to a PCI centre can be ensured in ≤120 min. We evaluated the ambulance driving time to primary PCI centres in the Netherlands and assessed to what extent ambulance driving times were impacted by the expansion of off-site PCI centres. Methods and results We calculated the driving routes from every Dutch postal code to the nearest PCI centre with (on-site) or without (off-site) surgical backup. We used data from ambulance records to estimate the ambulance driving time on each route. There were 16 on-site and 14 off-site PCI centres. The median (interquartile range) time to on-site PCI centres was 18.8 min (12.2–26.3) compared with 14.9 min (8.9–20.9) to any PCI centre (p < 0.001). In postal code areas that were impacted by the initiation of off-site PCI, the median driving time decreased from N. P. G. Hoedemaker () Heart Centre, Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands [email protected] N. P. G. Hoedemaker · R. J. de Winter · R. Adams · S. E. van den Bosch Heart Centre, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, AMC/University of Amsterdam, Amsterdam, The Netherlands G. J. Kommer · H. Giesbers National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands P. Damman Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
25.4 (18.2–33.1) to 14.7 min (8.9–20.9) (p < 0.001). Ambulance driving times of >120 min were only seen in non-mainland areas. Conclusion Based on a computational model, timely ambulance transfer to a PCI centre within 120 min is available to almost all STEMI patients in the Netherlands. Expansion of off-site PCI has significantly reduced the driving time to PCI centres. Keywords STEMI · Off-site PCI · Time delay
Introduction Percutaneous coronary intervention (PCI) is a commonly used treatment strategy for coronary revascularisation in both stable coronary artery disease and acute coronary syndrome (ACS) [1]. In the past 20 years, PCI has become a cornerstone in ACS treatment, particularly in patients with ST-segment elevation myocardial infarction (STEMI) [2]. Timely treatment plays an important role in the prognosis of STEMI patients [3]. In STEMI patients with symptoms for 60 km from a PCI centre is associated with an increased total ischaemic time in STEMI patients [15]. All data and statistical analyses were performed using R (GJK and HG).
Results On 1 January 2019, there were 30 PCI c
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