Management and outcomes of STEMI in a regional non-24/7 cardiac catheterisation lab

Abstract

Background: Numerous challenges are associated with the management of STEMI in regional Australia due to geographical distance prolonging transfers and lack of 24/7 cardiac services. We investigated the management and outcomes of STEMI patients presenting to Port Macquarie Base Hospital (PMBH) which operates a non-24/7 cath lab service. Method(s): A retrospective analysis was conducted on out-of-hospital STEMIs in 2018-19. Late presenting and aborted STEMIs were excluded. Result(s): 90 patients had STEMIs meeting inclusion criteria. 60% (n=54) underwent primary PCI and 40% (n=36) were thrombolysed. Of thrombolysed patients, 28% (n=10) received pre-hospital thrombolysis. 42% (n=38) of STEMIs presented when the lab was open, 34% (n=31) when on-call and 23% (n=21) while closed. The rates of thrombolysis increased from when the lab was open (11%), on-call (42%) to closed (91%) (p<0.0001). 85% (n=73) of STEMIs presented to PMBH, while 18% (n=17) were transferred from peripheral hospitals. There were higher rates of thrombolysis at peripheral hospitals (59% vs. 36%, P = 0.08). Door-to-needle time (thrombolysis) was shorter than door-to-balloon time (primary PCI) (medians 46min vs. 102min, p=0.0006). Door-to-balloon time was significantly longer in peripheral hospital transfers (medians 98min vs. 178min, p=0.037). Door-to-lab-arrival time was significantly longer during on-call vs. open hours (medians 72min vs. 39min, p=0.027). There was no significant difference in major adverse cardiac events at 12 months between primary PCI and thrombolysis (9.3% vs. 14.3%, p=0.29). Conclusion(s): This audit demonstrates both reperfusion strategies are safe and effective in the management of STEMI in a regional centre with a non-24/7 cath lab service.