But because PCI is only available in hospitals with cath labs, FT remains the standard of care in most U.S. hospitals. It would appear that the thing to do is to start building cath labs.
The authors of "Comparative Effectiveness of STEMI Regionalization Strategies" suggest that it is not necessarily cost-effective for a regional hospital to have a cath lab, so long as proper strategies for the emergency transport of STEMI patients to PCI-capable hospitals are in place. The study cites data from a separate paper, which found that "80% of the U.S. population lives within a one-hour drive of a PCI facility, but fewer than 80% of eligible patients with STEMI actually receive PCI."
Researchers say that the most cost-effective solution is to devise a two-pronged strategy to enhance PCI access within a region: build capacity using hospital-based strategies, and leverage access by using an emergency medical service strategy.
This risk/benefit analysis applied to the STEMI/PCI question is objective and the study's conclusions are logical. But who will be able to convince hospital CEOs that they should pass up the opportunity to build out a service line in favor of collaborating with other, often competing hospitals and EMS services, to hammer out a logistical plan that may ultimately result in fewer (STEMI) patients coming through the doors? That's a tough sell.