Association of a Comprehensive ST‐Segment–Elevation Myocardial Infarction Protocol With Key Process Metrics Among Patients Transferred for Primary Percutaneous Coronary Intervention
Background Most US patients with ST‐segment–elevation myocardial infarction (STEMI) transferred for percutaneous coronary intervention (PCI) do not achieve the goal door‐to‐balloon time (D2BT) of ≤120 minutes. We evaluated the impact of a comprehensive STEMI protocol (CSP) implemented in our health...
Saved in:
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2025-05-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.034054 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Summary: | Background Most US patients with ST‐segment–elevation myocardial infarction (STEMI) transferred for percutaneous coronary intervention (PCI) do not achieve the goal door‐to‐balloon time (D2BT) of ≤120 minutes. We evaluated the impact of a comprehensive STEMI protocol (CSP) implemented in our health care system on STEMI process metrics in patients transferred for PCI. Methods AND RESULTS The CSP is a 4‐step protocol including (1) emergency department (ED) cardiac catheterization laboratory activation; (2) a STEMI Safe Handoff Checklist; (3) immediate transfer to an available cardiac catheterization laboratory; and (4) radial‐first approach to PCI. We compared the use of guideline‐directed medical therapy before angiography, radial‐first access, and D2BT in 1274 consecutive patients with STEMI transferred to our hospital for PCI before (pre‐CSP group; January 1, 2011, to July 14, 2014) and after (CSP group; July 15, 2014, to July 15, 2019) CSP implementation. The study population included 499 patients in the pre‐CSP group and 775 patients in the CSP group. After CSP implementation, guideline‐directed medical therapy before angiography (84.6% versus 93.9%, P<0.001) and radial access (19.0% versus 77.7%, P<0.001) both increased significantly. Median D2BT decreased from 114 (interquartile range, 94–146 minutes) to 97 minutes (interquartile range, 82–115 minutes; P<0.001) after CSP implementation, with substantially more patients treated with D2BT of ≤120 minutes (55.7% versus 80.1%, P<0.001). Achievement of D2BT <120 minutes in the CSP group was associated with a 50% relative risk reduction in the 30‐day mortality rate (odds ratio, 0.50; P=0.04) and an absolute risk reduction of 0.7%. Conclusions In patients with STEMI transferred for PCI, a standardized protocol for STEMI care was associated in improvements in key process metrics (guideline‐directed medical therapy, radial access, and D2BT) with associated reduction in the 30‐day mortality rate. |
|---|---|
| ISSN: | 2047-9980 |