Primary PCI in ST-Segment Elevation Myocardial Infarction

To the Editor: Le May et al. (Jan. 17 issue)¹ achieved guideline-recommended door-to-balloon times of less than 90 minutes for 79.7% of patients with ST-segment elevation myocardial infarction when paramedics interpreted the electrocardiograms (ECGs) and directly referred the patients to a percutaneous coronary intervention (PCI) center, as compared with 11.9% of patients referred from emergency departments of the area's hospitals (including the PCI center). Since about 50% of patients with ST-segment elevation myocardial infarction transport themselves to the hospital,² they would not benefit from this approach and would be at risk for undergoing treatment after the recommended door-to-balloon time. Exceeding . . .