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

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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.
Original languageEnglish
Pages (from-to)584-594
Number of pages11
JournalNetherlands Heart Journal
Volume28
Issue number11
Early online date2020
DOIs
Publication statusPublished - 1 Nov 2020

Keywords

  • Off-site PCI
  • STEMI
  • Time delay

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