Rationale for establishing regional ST-elevation myocardial infarction receiving center (SRC) networks

Recent developments have provided a unique opportunity for the organization of regional ST-elevation myocardial infarction (STEMI) receiving center (SRC) networks. Because cumulative evidence has demonstrated that rapid primary percutaneous coronary intervention (PCI) is the most effective reperfusion strategy for acute STEMI, the development of integrated SRC networks could extend the benefits of primary PCI to a much larger segment of the US population. Factors that favor the development of regional SRC networks include results from recently published clinical trials, insight into contemporary STEMI treatment patterns from observational registries, experience with the nation's current trauma system, and technological advances. In addition, the 2004 American College of Cardiology/American Heart Association STEMI guidelines have specified that optimal "first medical contact-to-balloon" times should be <90 minutes, so a clear benchmark for timely reperfusion has been established. Achievement of this benchmark will require improvements in the current process of care as well as increased multidisciplinary cooperation between emergency medical services, emergency medicine physicians, and cardiologists. Two types of regional SRC networks have already begun to evolve in role-model cities, including prehospital cardiac triage and interhospital transfer. Regional coordination of SRC networks is needed to ensure quality monitoring and to delineate the ideal reperfusion strategy for a given community based on available resources and expertise.