{"id":14294,"date":"2011-11-30T13:47:50","date_gmt":"2011-11-30T18:47:50","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=interventional&p=14294"},"modified":"2011-12-01T15:41:26","modified_gmt":"2011-12-01T20:41:26","slug":"should-fedex-be-in-charge-of-primary-pci","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2011\/11\/30\/should-fedex-be-in-charge-of-primary-pci\/","title":{"rendered":"Should FedEx Be in Charge of Primary PCI?"},"content":{"rendered":"

Federal Express built its business on being a leader in transportation and delivering on time. \u00a0Perhaps the results of primary PCI in the U.S. would be better if FedEx ran the program.<\/strong><\/p>\n

In patients with acute MI who must be transferred to another hospital for primary PCI, experts agree that the door-in to door-out (so called, DIDO) time should not exceed 30 minutes.\u00a0 Two studies\u00a0\u2014 one from the Get With the Guidelines ACTION Registry <\/a>and the other from CMS data<\/a>\u00a0\u2014 show that only \u224810% of patients transferred for PCI in the U.S. are delivered on time (i.e., DIDO <30 minutes). Distressingly, DIDO was more than 90 minutes in\u00a0about one third\u00a0of patients and more than 110 minutes in 25%.<\/p>\n

If primary PCI were a business (i.e., FedEx), the transfer unit of the company would be in bankruptcy proceedings.\u00a0 \u00a0<\/em><\/strong><\/p>\n

Customers complain about packages that are delivered late, but little outrage is voiced over patients whose acute MI treatment is unnecessarily delayed, leading to a higher mortality.\u00a0 In fact, DIDO time has not changed much over the past 5 years, and the problem is not limited to rural hospitals. \u00a0In another recent study <\/a>from a hospital in a major metropolitan area, the median DIDO time was >130 minutes, even though\u00a0four primary PCI-capable hospitals were located within 5 miles.<\/p>\n

The message for hospitals\u00a0that advocate transfer of primary PCI patients should be the same as it would be for FedEx: deliver the goods on time or get out of the business.<\/em><\/strong><\/p>\n

In an accompanying editorial<\/a>, Rita Redberg notes that \u201cmodern thrombolytic strategies have substantially attenuated the mortality benefit of primary PCI over thrombolytic therapy such that differences are trivial except for the highest-risk subgroup.\u201d\u00a0 For acute MI patients who present to a hospital without primary PCI capability, thrombolytic therapy should be administered, and transfer \u201cshould not be performed unless the patient is at high risk and there is reason to believe that with transfer the patient will receive primary PCI within 60 minutes.\u201d Dr. Redberg also offers a short post on this topic here at CardioExchange<\/a>.<\/p>\n

If\u00a0you were to present with an acute MI to a hospital without primary PCI capability, which would you choose: immediate thrombolytic therapy or transfer (without knowing what the DIDO time will be)?\u00a0 <\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

Federal Express built its business on being a leader in transportation and delivering on time. \u00a0Perhaps the results of primary PCI in the U.S. would be better if FedEx ran the program. In patients with acute MI who must be transferred to another hospital for primary PCI, experts agree that the door-in to door-out (so […]<\/p>\n","protected":false},"author":214,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1,9],"tags":[884,245,302,257,1053],"class_list":["post-14294","post","type-post","status-publish","format-standard","hentry","category-general","category-interventional-cardiology","tag-dido","tag-mi","tag-primary-pci","tag-stemi","tag-thrombolytics"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/14294","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/214"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=14294"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/14294\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=14294"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=14294"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=14294"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}