TY - JOUR T1 - Providing optimal regional care for ST-segment elevation myocardial infarction: a prospective cohort study of patients in the Hamilton Niagara Haldimand Brant Local Health Integration Network JF - CMAJ Open SP - E1 LP - E7 DO - 10.9778/cmajo.20140035 VL - 3 IS - 1 AU - Mathew Mercuri AU - Michelle Welsford AU - Jon-David Schwalm AU - Shamir R Mehta AU - Purnima Rao-Melacini AU - Nicholas Valettas MD MASc AU - Tej Sheth AU - Michael Rokoss AU - Sanjit S. Jolly AU - James L. Velianou AU - Madhu K. Natarajan Y1 - 2015/01/13 UR - http://www.cmajopen.ca/content/3/1/E1.abstract N2 - Background Although considered the evidence-based best therapy for ST-segment elevation myocardial infarction (STEMI), many patients do not receive primary percutaneous coronary intervention (PCI) because of health care resource distribution and constraints. This study describes the clinical management and outcomes of all patients identified with STEMI within a region, including those who did not receive primary PCI. Methods This study used a prospective cohort design. Patients presenting with STEMI to PCI- and non−PCI-capable hospitals in one integrated health region in Ontario were included in the study. The primary objective was to examine use of reperfusion strategies and timeliness of care. Secondary objectives included determining (through regression models) which variables were associated with mortality within 90 days, and describing patient uptake of risk-reducing therapies and activities post-STEMI. Results Between Apr. 1, 2010, and Mar. 31, 2013, data were collected on 2247 consecutive patients presenting with STEMI. Patients presenting to the PCI-capable hospital were more likely to receive primary PCI (82.5% v. 65.2%, p < 0.001) and be treated within optimal treatment times. However, there was no appreciable difference in mortality at 90 days post-STEMI between patients presenting to PCI- and non−PCI-capable hospitals (7.8% v. 7.5%, p = 0.82), even after adjustment for acuity on presentation. Despite recognized risk factors, many patients were not taking evidence-based medications for risk factor modification before STEMI. Interpretation A systematic approach to regional STEMI care focusing on timely access to the best available therapies, rather than the type of reperfusion provided alone, can yield favourable outcomes. ER -