Rationale for establishing regional ST-elevation myocardial infarction receiving center (SRC) networks

Rokos, Ivan C.; Larson, David M.; Henry, Timothy D.; Koenig, William J.; Eckstein, Marc; French, William J.; Granger, Christopher B.; Roe, Matthew T.

doi:10.1016/j.ahj.2006.06.001

« Previous Next »American Heart Journal
Volume 152, Issue 4 , Pages 661-667, October 2006

Rationale for establishing regional ST-elevation myocardial infarction receiving center (SRC) networks

Ivan C. Rokos, MD
- Department of Emergency Medicine, Olive View-University of California Los Angeles (UCLA), Los Angeles, CA
- Reprint requests: Ivan C. Rokos, MD, Olive View-UCLA, Department of Emergency Medicine, Geffen School of Medicine at UCLA, 14445 Olive View Dr, Sylmar, CA 91342.
David M. Larson, MD
- Department of Emergency Medicine, Ridgeview Medical Center, Waconia, MN
Timothy D. Henry, MD
- Minneapolis Heart Institute, Minneapolis, MN
William J. Koenig, MD
- Los Angeles County Emergency Medical Services Agency, Los Angeles, CA
Marc Eckstein, MD
- Department of Emergency Medicine, Los Angeles County/University of Southern California (LAC/USC), Los Angeles, CA
William J. French, MD
- Harbor-University of California Los Angeles (UCLA), Los Angeles, CA
Christopher B. Granger, MD
- Duke University Medical Center, Durham, NC
Matthew T. Roe, MD, MHS
- Duke University Medical Center, Durham, NC

Received 8 February 2006; accepted 4 June 2006. published online 29 August 2006.

Recent developments have provided a unique opportunity for the organization of regional ST-elevation myocardial infarction (STEMI) receiving center (SRC) networks. Because cumulative evidence has demonstrated that rapid primary percutaneous coronary intervention (PCI) is the most effective reperfusion strategy for acute STEMI, the development of integrated SRC networks could extend the benefits of primary PCI to a much larger segment of the US population. Factors that favor the development of regional SRC networks include results from recently published clinical trials, insight into contemporary STEMI treatment patterns from observational registries, experience with the nation's current trauma system, and technological advances. In addition, the 2004 American College of Cardiology/American Heart Association STEMI guidelines have specified that optimal “first medical contact-to-balloon” times should be <90 minutes, so a clear benchmark for timely reperfusion has been established. Achievement of this benchmark will require improvements in the current process of care as well as increased multidisciplinary cooperation between emergency medical services, emergency medicine physicians, and cardiologists. Two types of regional SRC networks have already begun to evolve in role-model cities, including prehospital cardiac triage and interhospital transfer. Regional coordination of SRC networks is needed to ensure quality monitoring and to delineate the ideal reperfusion strategy for a given community based on available resources and expertise.