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 back-up. 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 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.
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Details
1 Onze Lieve Vrouwe Gasthuis, Heart Centre, Department of Cardiology, Amsterdam, The Netherlands (GRID:grid.440209.b); AMC/University of Amsterdam, Heart Centre, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Amsterdam, The Netherlands (GRID:grid.7177.6) (ISNI:0000000084992262)
2 AMC/University of Amsterdam, Heart Centre, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Amsterdam, The Netherlands (GRID:grid.7177.6) (ISNI:0000000084992262)
3 National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands (GRID:grid.31147.30) (ISNI:0000 0001 2208 0118)
4 Radboud University Medical Centre, Department of Cardiology, Nijmegen, The Netherlands (GRID:grid.10417.33) (ISNI:0000 0004 0444 9382)