Background: The management of ST-elevation myocardial infarction (STEMI) in Ireland changed with the introduction of the National Acute Coronary Syndrome (ACS) model of care in 2012. The model heralded the implementation of a national Primary Percutaneous Coronary Intervention (PPCI) Programme to minimise time to treatment using PPCI in STEMI patients. The programme mandates reperfusion to treat STEMI using PPCI within 120-minutes from first 12 lead ECG diagnosis. Irish data on times to PPCI is limited.
Purpose: The study established cross-sectional data of PPCI patients in an Irish PPCI centre. Objectives included;
1. Ascertain reperfusion time (RT) in all PPCI during the study period.
2. Identify whether patients achieved RT in<120-minutes.
3. Examine factors associated with RT.
Methods: The study was a non-experimental, cross-sectional descriptive design. To be included, patients were diagnosed with STEMI, based on the European Society of Cardiology (ESC 2012) criteria and admitted for emergency PPCI during the 3-month data collection period. Descriptive and inferential statistics were used. The study was ethically approved.
Results: There were 133 patients that met the inclusion criteria initially. Of these, 105 (79%) received PPCI, while the remaining 28 had differential diagnosis, based on their angiogram. The sample was 74% (N=99) male and the mean age was 62 +/− 11.97 years. 67% of PPCI patients achieved RT within 120-minutes from 12 lead ECG diagnosis, with a median RT of 96 minutes. The majority of STEMIs (46%) were diagnosed by paramedics. In this study, there was a significant difference (p=0.006) in the mean age of patients with a RT of <120 minutes (Mean: 59.6, SD: 11.1) and the mean age of those with a RT >120 minutes (Mean: 66.5, SD:13.26), suggesting that younger patients achieve RT in <120 minutes. Source of referral was also significant (p=0.001), in that patients (n=44, 81%) who were transferred directly to the Coronary catheterisation laboratory and bypassed Emergency Departments and non PPCI centres achieved reperfusion within the recommended 120 minutes.
Conclusion: The results suggest that a timely service to STEMI patients is being provided. However 33% fall outside the recommended RT timeframe of 120 minutes. There is scope to further improve these times. The results reported that both age and source of referral were found to be associating factors in achieving reperfusion times within 120 minutes. This study recommends a multi-centre study to represent the greater Irish STEMI population.