Direct Paramedic Transport of Acute Myocardial Infarction Patients to Percutaneous Coronary Intervention Centers: A Decision Analysis

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.annemergmed.2008.07.020 Byline: Henry E. Wang (a), Oscar C. Marroquin (b), Kenneth J. Smith (c) Abstract: One potential strategy in the emergency medical services (EMS) care of acute ST-segment elevation myocardial infarction (STEMI) is to bypass the nearest community hospital in favor of a more distant specialty center able to perform primary percutaneous coronary intervention. We seek to determine whether EMS transport of out-of-hospital STEMI patients directly to more distant specialty percutaneous coronary intervention centers will alter 30-day survival compared with transport to the nearest community hospital fibrinolytic therapy. Author Affiliation: (a) Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA (b) Cardiovascular Institute, University of Pittsburgh, Pittsburgh, PA (c) Section of Decision Sciences, Department of Medicine, University of Pittsburgh, Pittsburgh, PA Article History: Received 27 February 2008; Revised 13 June 2008; Accepted 17 July 2008 Article Note: (footnote) Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Dr. Wang is supported by Clinical Research Development Award K08-HS013628 from the Agency for Healthcare Research and Quality, Rockville, MD., Earn CME Credit: Continuing Medical Education is available for this article at: www.ACEP-EMedHome.com., Supervising editor: Kathy J. Rinnert, MD, MPH, Author contributions: HEW conceived the study. HEW, OCM, and KJS designed the analysis. HEW carried out the analysis. All authors contributed substantially to the writing and editing of the article. HEW takes responsibility for the paper as a whole., Reprints not available from the authors., Publication date: Available online September 18, 2008.