Effect of a new, decentralized PCI-centre at Nordland Hospital on the quality of STEMI-treatment in the Salten region.

Abstract

Background. In February 2020, a percutaneous coronary intervention (PCI) centre was established at Nordland Hospital Bodø (NLSH), offering daytime primary PCI for ST-elevation myocardial infarction (STEMI) patients from the Salten region. Outside opening hours, patients receive thrombolysis and are transported to the University Hospital of Northern Norway in Tromsø (UNN). This study compares process-of-care measures and explores patient outcomes during and outside opening hours in 2020-2024. Methods. We included STEMI patients from the Salten region treated between 1 February 2020 and 31 October 2024. We analysed quality indicators, time to reperfusion, and the exploratory combined endpoint of death within 30 days or ejection fraction (EF) <50% at discharge. Results. Eighty-eight patients were treated at UNN and 81 at NLSH. Treatment met quality targets in 67% during opening hours versus 11% outside opening hours. Median time from ECG to definitive reperfusion with thrombolysis or PCI was 65 min at NLSH versus 160 min at UNN. Among patients who did not receive or respond to thrombolysis, median time to reperfusion was 70 versus 235 min, respectively. Of patients considered for thrombolysis, 46% received thrombolysis with a clinically judged successful response. Longer time to definitive reperfusion was associated with reduced EF at discharge or death within 30 days. Conclusions. When local daytime PCI was available in Bodø, a higher proportion of patients met established quality targets and time to definitive reperfusion was substantially shorter for STEMI-patients from the Salten region. Among patients considered for thrombolysis, 46% received thrombolysis with a clinically judged successful response.