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To the Editor: The Commentary on regionalization of care for acute coronary syndromes (ACS) by Mr Rathore and colleagues¹ did not directly address the most important advantage of transporting patients to hospitals with percutaneous coronary intervention (PCI) capability. The focus should not be the broad condition of ACS, but rather the individual patient with ST-elevation myocardial infarction (STEMI). Primary studies and quantitative reviews show that, for STEMI patients, PCI improves outcomes compared with intravenous fibrinolytic therapy.² This is especially true for the combined end point of death, recurrent ischemia, or stroke, even in hospitals with new PCI programs using higher volume operators.³

New approaches in emergency medical services systems allow rapid transport to PCI centers. Patients with STEMI now can be identified in the out-of-hospital setting using a 12-lead electrocardiogram with machine interpretation, which is a class I recommendation from the American Heart Association.⁴ The out-of-hospital electrocardiogram identifies STEMI patients . . . [Full Text of this Article]

Bruce E. Haynes, MD
BHaynes@ochca.com
EMS Medical Director
Santa Ana, Calif

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