Feasibility of implementing reperfusion strategies in STEMI codes in a mountainous population remote from a PCI-capable center.

Introduction and objectives: ST-segment elevation myocardial infarction (STEMI) requires early coronary reperfusion to reduce mortality and improve prognosis. In rural areas, timely access to reperfusion therapies, including fibrinolysis or percutaneous coronary intervention (PCI) is frequently constrained by logistical and health care system-related factors.This study aimed to identify factors associated with delays in reperfusion and those associated with mortality in patients with STEMI code activation in a mountainous European region. Methods: This is an observational, retrospective, and quantitative study in Alt Pirineu-Aran region (Catalonia, Spain) from 2015 through 2020. Sociodemographic and geographic factors, clinical status, resource management and the treatment provided were analyzed using data from the STEMI code registry and the Catalan emergency medical system. Results: During the study period, a total of 221 patients with STEMI code were treated in the Alt Pirineu-Aran region. Patients ranged in age from 27 to 96 years, with a mean age of 64.7 years; 72.4% were men. Of these, 47 received fibrinolytic therapy and 173 were transferred to a PCI-capable center, of whom 162 underwent PCI; in 11 cases the code was deactivated. Most patients transferred for PCI experienced delays of > 120 minutes from the diagnostic electrocardiogram. Helicopter transport improved treatment times, with the greatest benefit observed in primary transfers. The 15-day mortality rate was 8.1%. Conclusions: Most fibrinolysis treatments and PCI were not performed within the times recommended by the European clinical practice guidelines. The study highlights the underutilization of fibrinolysis.