TUESDAY, July 27 (HealthDay News) -- Hospital-based strategies for increasing patient access to primary percutaneous coronary intervention (PCI) for treatment of ST-segment elevation myocardial infarction (STEMI) may not be the best option in terms of cost and effectiveness if emergency medical services (EMS) are sufficient for getting patients to the care they need, according to research published online July 27 in Circulation: Cardiovascular Quality and Outcomes.

Thomas W. Concannon, Ph.D., of Tufts Medical Center and the Tufts University School of Medicine in Boston, and colleagues simulated care in a regional hospital system to estimate the incremental costs and quality-adjusted life expectations for 2,000 STEMI patients receiving PCI or fibrinolytic therapy. To increase access to PCI, they compared a base case strategy with 12 hospital-based approaches involving building new PCI laboratories and lengthening operating hours of existing labs and an EMS-based approach that involved transporting each STEMI patient to an existing PCI-capable facility.

The researchers found that the estimated base case led to 609 patients getting PCI. Hospital-based strategies raised the number of patients treated with PCI, quality-adjusted life years saved, as well as care costs (while being generally cost effective); however, the EMS-based strategy proved less expensive and more effective than any of the 12 hospital options considered.

"Our results suggest that new construction and staffing of PCI laboratories may not be warranted if an EMS strategy is both available and feasible," the authors write.

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