Related Experiment Video
Updated: Jul 4, 2026
Improvement of a Closed Chest Porcine Myocardial Infarction Model by Standardization of Tissue and Blood Sampling Procedures
Published on: March 12, 2018
Reperfusion times for ST elevation myocardial infarction: a prospective audit
Kendeep S Kaila1, Kapil M Bhagirath, Malek Kass
1Department of Medicine, University of Manitoba, and Department of Emergency Medicine, St. Boniface General Hospital, Manitoba.
Insights
This study found that a tertiary care center did not meet recommended treatment times for ST elevation myocardial infarction (STEMI). Implementing a dedicated EKG machine showed a trend toward improvement but did not significantly shorten overall reperfusion delays.
Area of Science:
- Cardiology
- Emergency Medicine
- Healthcare Quality Improvement
Background:
- New guidelines recommend ST elevation myocardial infarction (STEMI) treatment within 30 minutes for thrombolysis and 90 minutes for primary percutaneous coronary intervention (PCI).
- Tertiary care centers face challenges in meeting these time-sensitive treatment goals.
Purpose of the Study:
- To assess a tertiary care center's adherence to STEMI treatment guidelines.
- To evaluate the effectiveness of interventions aimed at reducing treatment delays.
Main Methods:
- A prospective audit loop utilizing retrospective chart review was conducted.
- Key time intervals evaluated included ER presentation to diagnostic EKG (T2), ER presentation to reperfusion (T ER), and first medical contact to reperfusion (T AHA).
- Interventions included staff education and placement of a dedicated EKG machine in the ER.
Main Results:
- In 2003-4, 70.7% of STEMI patients received reperfusion; median T AHA was 54 minutes for thrombolysis and 58 minutes for PCI.
- In 2004-5, 76.9% received reperfusion, with only 14.3% (thrombolysis) and 11.1% (PCI) meeting guideline times.
- A dedicated EKG machine showed a trend toward improving T2 (22 vs 10 minutes, P=0.07) but did not impact other treatment times.
Conclusions:
- Treatment times at the tertiary care center exceeded recommended STEMI guidelines.
- More comprehensive strategies and improved inter-departmental coordination are necessary to reduce pre- and post-contact response times for STEMI patients.
Background:
New published guidelines recommend treatment of ST elevation myocardial infarction (STEMI) within 30 minutes of first medical contact to thrombolysis and 90 minutes to primary percutaneous coronary intervention (PCI).
Objectives:
To determine how a tertiary care center compares to these new guidelines and to evaluate the success of measures directed to shorten delays.
Methods:
This was a prospectively designed audit loop using retrospective chart review. Specific time intervals were evaluated: 1) T2 (ER presentation to diagnostic EKG; 2) T ER (ER presentation to reperfusion); and 3) T AHA (first medical contact to reperfusion). Results of the initial 12-month data were conveyed to Emergency Room staff and a dedicated EKG machine was placed in the ER for the subsequent 12 months, and the results were then re-analyzed.
Results:
In 2003-4, 58 patients with STEMI were identified, with 41 (70.7%) receiving reperfusion. Of those receiving thrombolysis, median T AHA was 54 [37-72] minutes, with 12.0%<30 minutes, while those receiving PCI, median T AHA was 58 [43-78] minutes, with 25.0%<90 minutes. In 2004-5, 52 patients had STEMI, with 40 (76.9%) receiving reperfusion. The percentage of patients meeting the guidelines was 14.3% for the thrombolysis group and 11.1% for the PCI group. Introduction of a dedicated EKG machine led to a strong trend towards improvement in median T2 (22 vs 10 minutes; P=0.07), but other treatment times remained unchanged.
Conclusions:
Treatment times are longer than recommended guidelines. More comprehensive strategies and improved coordination of medical services are required to shorten pre-contact and post-contact response times.
