Quality dimensions of primary percutaneous coronary intervention: timeliness, access, and availability.

For patients with ST-segment–elevation myocardial infarction (STEMI), primary percutaneous coronary intervention (PCI) is superior to fibrinolytic therapy if primary PCI is performed (1) in a timely manner with a door-toballoon time 90 minutes; (2) by experienced operators and PCI hospitals; (3) and for patients who have high clinical risk, high bleeding risk, or delays in presentation from symptom onset.1 Current guidelines and the Centers for Medicare and Medicaid Services public reporting have focused on the timeliness of primary PCI, particularly door-to-balloon time as a process measure of quality.2 Given the better outcomes achievable with primary PCI, there is growing interest in regionalizing STEMI care to improve access to primary PCI.3,4 However, 25% of US hospitals have PCI capability,4 and observational registries demonstrate that 10% of patients who are transferred for primary PCI achieve a first door-to-balloon time 90 minutes.5 The American Heart Association “Mission: Lifeline” initiative is seeking to improve timely access to primary PCI for patients who present to non-PCI hospitals by engaging patients and communities, emergency medical services, hospital systems, emergency department physicians, cardiologists, health agencies, policy makers, and payers.