I’m not sure why this is earthshaking news – other than some good statisticians had access to some good data. Of course, that’s pretty much what research is about – have data, will travel.
This JAMA article looks at door-in-door-out time for STEMI at transferring hospitals – and they suggest an association between between quicker transfer times and unadjusted mortality. There is still some debate regarding how much time to primary PCI matters, but, if you say this in-and-out time is a surrogate marker for time to primary PCI, you could presumably support the hypothesis of rapid PCI mattering.
There are a few interesting nuggets of information in the article – particularly looking at patients for whom the transfer time was exceptionally prolonged. Essentially, left bundle and patients with ambiguous or non-obvious STEMI were delayed. I.e., when the diagnosis is hard, it’s hard to make the diagnosis.
As usual, time matters to the individual, but system factors affect many patients. Mortality for STEMI is improved by faster transport, but you still need to consider the consequences of faster transport. Reckless abandon towards shoving a semi-stable patient out the door won’t always lead to better outcomes, but, then again, I have worked in some of those hospitals….
“Association of Door-In to Door-Out Time With Reperfusion Delays and Outcomes Among Patients Transferred for Primary Percutaneous Coronary Intervention.”
http://www.ncbi.nlm.nih.gov/pubmed/21693742