Part-time hemodynamics due to inequity in the reperfusion therapy of patients with STEMI

Abstract

Dear editor, In Spain the implementation of ST-segment elevation acute myocardial infarction (STEMI) networks between 2003 and 2012 was associated to a higher rate (50%) of primary percutaneous coronary interventions (PCI) and a lower mortality rate (that dropped from 10.2% to 6.8%). However, throughout the years we have been able to witness the appearance of inevitable differences in the development and implementation of primary PCI programs among the different regions.1 And, although these differences are slowly disappearing, some situations can generate inequity while managing reperfusion. One of these differences can be found in those interventional laboratories that only do primary PCIs part-time ignoring the recommendations from the European Society of Cardiology that establishes that primary PCI-capable centers should conduct this procedure on a 24/7 schedule and categorizes other healthcare models as “non-desirable”.2 Thus, given the limited availability of our hospital interventional laboratory (from 8 AM through 3 PM only on business days), we decided to explore the in-hospital mortality rate of patients with STEMI who received primary PCIs in our center and compare it to that of patients who received another reperfusion therapy (primary PCI at the regional reference center or fibrinolysis). Our hemodynamic laboratory provides healthcare to nearly 400 000 inhabitants. Whenever...