When local daytime PCI was available in Bodø, a higher proportion of patients met established quality targets and time to definitive reperfusion was substantially shorter for STEMI-patients from the Salten region.
Key Findings
Results
A higher proportion of STEMI patients met quality targets when treated during opening hours at the local PCI centre compared to outside opening hours.
Treatment met quality targets in 67% of patients during opening hours versus 11% outside opening hours.
81 patients were treated at Nordland Hospital Bodø (NLSH) and 88 patients were treated at University Hospital of Northern Norway in Tromsø (UNN).
The study period was 1 February 2020 to 31 October 2024.
NLSH offered daytime primary PCI; outside opening hours, patients received thrombolysis and were transported to UNN.
Results
Median time from ECG to definitive reperfusion was substantially shorter at the local PCI centre compared to the referral centre.
Median time from ECG to definitive reperfusion was 65 minutes at NLSH versus 160 minutes at UNN.
Among patients who did not receive or respond to thrombolysis, median time to reperfusion was 70 minutes at NLSH versus 235 minutes at UNN.
Definitive reperfusion was defined as either thrombolysis or PCI.
The difference of 165 minutes in the thrombolysis non-responder group represents a more than threefold longer time for UNN-treated patients.
Results
Among STEMI patients considered for thrombolysis, 46% received thrombolysis with a clinically judged successful response.
This finding applied to patients treated outside opening hours who were therefore considered for thrombolysis before transport to UNN.
A clinically judged successful response was the criterion used to classify thrombolysis as effective.
Patients who did not receive or did not respond to thrombolysis faced substantially longer times to definitive reperfusion (235 minutes at UNN).
This figure highlights that a majority of patients considered for thrombolysis either did not receive it or did not respond successfully.
Results
Longer time to definitive reperfusion was associated with reduced ejection fraction at discharge or death within 30 days.
The combined exploratory endpoint consisted of death within 30 days or ejection fraction (EF) less than 50% at discharge.
The association suggests a clinically meaningful relationship between treatment delays and worse patient outcomes.
This was described as an exploratory endpoint, indicating the study was not primarily powered to detect this association.
The finding is consistent with the known time-dependent nature of myocardial salvage in STEMI.
Background
The decentralized PCI centre at Nordland Hospital was established in February 2020 and offered daytime primary PCI for STEMI patients from the Salten region.
Prior to this, all STEMI patients from the Salten region requiring PCI were transported to UNN in Tromsø.
Outside opening hours, the hybrid strategy of thrombolysis followed by transport to UNN remained in place.
The study compared process-of-care measures and patient outcomes during and outside opening hours over a period spanning February 2020 to October 2024.
A total of 169 STEMI patients from the Salten region were included in the analysis.
What This Means
This research studied what happened to heart attack patients in the Salten region of Norway after a local heart catheterization (PCI) center opened at Nordland Hospital in Bodø in 2020. Before this center opened, all patients needing this procedure had to be transported to a larger hospital in Tromsø, which is much farther away. The study compared 81 patients treated locally during the center's daytime hours with 88 patients treated outside those hours, who still needed to receive clot-dissolving medication (thrombolysis) and be transported to Tromsø.
The results showed striking differences in treatment speed. When the local center was open, the median time from an initial heart tracing (ECG) to opening the blocked artery was 65 minutes, compared to 160 minutes for patients sent to Tromsø. For patients who needed emergency PCI because the clot-dissolving medication didn't work, the gap was even larger — 70 minutes locally versus 235 minutes at the distant hospital. More patients also met established medical quality targets when treated locally (67% versus 11%). The study also found that longer delays to treatment were associated with worse outcomes, specifically lower heart pumping function at discharge or death within 30 days.
This research suggests that establishing a local, decentralized PCI center can dramatically reduce the time it takes for heart attack patients in geographically remote regions to receive life-saving treatment. However, because the center only operates during daytime hours, patients who have heart attacks outside those hours still face long delays due to the need for transport to a distant facility. The finding that only 46% of patients considered for thrombolysis had a successful response to it further highlights the limitations of the after-hours strategy and points to the potential value of expanding local PCI availability.
Kjellmo C, Nymo S. (2026). Effect of a new, decentralized PCI-centre at Nordland Hospital on the quality of STEMI-treatment in the Salten region.. Scandinavian cardiovascular journal : SCJ. https://doi.org/10.1080/14017431.2026.2719261