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

Background In February 2020, a PCI center at Nordland Hospital Bodø (NLSH) was established, offering primary percutaneous coronary intervention (primary PCI) during daytime hours for STEMI-patients from the Salten region. Outside opening hours, patients are treated with thrombolysis and transported to the University Hospital of Northern Norway in Tromsø (UNN Tromsø). This study compares process-of-care measures, including established quality indicators and time to definitive reperfusion, and explores patient outcomes for STEMI-patients from the Salten region treated during and outside opening hours in the period 2020-2024.Methods The study included STEMI-patients from the Salten region treated between February 1, 2020, and October 31, 2024. Patients with more than 12 hours from symptom onset to first medical contact were excluded from the study. We analyzed quality indicators, time to reperfusion, and the exploratory combined endpoint of death within 30 days or ejection fraction below 50% at discharge.Results Eighty-eight patients were treated at UNN and 81 at NLSH. Sixty-seven percent received treatment within quality targets during opening hours, compared to 11% outside opening hours. Median time from ECG to definitive reperfusion with thrombolysis or PCI was 65 minutes at NLSH and 160 minutes at UNN. For patients who either did not receive or did not respond to thrombolysis, the median time to reperfusion was 70 minutes at NLSH and 235 minutes at UNN. Only 46% of patients considered for thrombolysis both received thrombolysis and had a clinically judged successful response. In exploratory analyses, longer time to definitive reperfusion was associated with reduced EF at discharge or death within 30 days.Conclusion 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.