Introduction of primary percutaneous coronary intervention for ST elevation myocardial infarction in a district general hospital

The objective of this study was to assess the feasibility and impact of providing a primary percutaneous coronary intervention (PCI) programme for ST elevation myocardial infarction (STEMI) in a district general hospital (DGH) in the UK.
A retrospective review of cardiac catheter laboratory PCI database records and hospital notes was carried out in a 950-bed teaching DGH in the West Midlands, serving a catchment population of 500,000. The patients consisted of 108 men and women aged 28–86 years presenting with thrombolysis-eligible STEMI, treated by primary PCI between November 2002 and August 2004. The main outcome measures used in this study were time from hospital presentation to PCI (‘door to coronary device’ time), mortality and hospital length of stay.
The median door to device time was 86 minutes (range 25 to 286). Some 78% and 52% of patients had door to device times of less than 120 and 90 minutes, respectively. Median length of hospital stay was five days (range 3–30), compared to eight days in patients treated with thrombolysis in the years 2000–2004. In-hospital mortality was seven patients (6.5%).
We conclude that, in the contemporary era of interventional cardiology, it is feasible to introduce a primary PCI service for STEMI in a DGH setting with acceptable ‘door to coronary device’ times and mortality.