Table 3. Network types according to existing resources.
| Primary PCI networks | |
|---|---|
| Ranking | Optimal long-term solution for STEMI care. |
| Mandatory resources | pPCI centres which can be reached within 90 min after symptom onset or diagnosis of STEMI; EMS coordinated with the network. |
| Primary therapies offered |
pPCI 24/7. If the pPCI centre is occupied or has a technical failure, a PI strategy is offered if pPCI cannot be offered within guideline-coherent timelines. |
| Processes | The EMS should bypass all other centres and transfer STEMI patients directly to the closest pPCI centre. |
| Hub-and-spoke PCI networks | |
| Ranking | Acceptable long-term solution for STEMI care. |
| Mandatory resources | pPCI centres; non-pPCI centres; EMS coordinated with the network. |
| Primary therapies offered | pPCI, PI strategy. |
| Processes | This model comprises two zones: the inner zone resembles a primary PCI network, the outer zone consists of non-pPCI centres or non-PCI hospitals which are connected to the inner zone via an EMS. They offer a PI strategy and either transfer the patient for PCI or perform PCI in the same place during office hours following the recommended timelines. |
| Important steps to upgrade | Turn non-pPCI centres into pPCI centres. |
| Pharmacoinvasive networks | |
| Ranking | Transient solution for STEMI care, should be upgraded in the midterm. |
| Mandatory resources | non-pPCI centres; an EMS, coordinated with the network, is highly desirable. |
| Primary therapies offered | PI strategy; primary PCI if patient arrives at PCI centre during office hours. |
| Processes | These networks offer a PI strategy 24/7 with fibrinolysis in all connected hospitals and either transfer the patient for PCI or perform PCI during office hours. pPCI is offered if patients arrive in a PCI hospital during office hours. |
| Important steps to upgrade |
1. Introduce an EMS, coordinated with the network. 2. Turn non-pPCI centres into 24/7 pPCI centres. |
| Fibrinolysis networks | |
| Ranking | Transient organisation which provides basic care for STEMI patients. Should be upgraded as early as possible. |
| Mandatory resources | Medical centres without PCI option, able to recognise a STEMI and handle fibrinolysis; an EMS, coordinated with the network is highly desirable; a remote ECG interpretation service can be useful. |
| Primary therapies offered | Stand-alone fibrinolysis. |
| Processes | These networks offer application of fibrinolysis 24/7. |
| Important steps to upgrade |
1. Introduce an EMS, coordinated with the network. 2. Install cath labs and expand their service to 24/7 pPCI. |
| cath lab: cardiac catheterisation laboratory; ECG: electrocardiogram; EMS: emergency medical service; FMC: first medical contact; PCI: percutaneous coronary intervention; PI: pharmacoinvasive; pPCI: primary percutaneous coronary intervention; STEMI: ST-elevation myocardial infarction | |