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Updated: Jun 18, 2026

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

A STEMI code protocol improves door-to-balloon time on weekdays and weekends.

Nidal Abi Rafeh¹, Dina Abi-Fadel, Robert V Wetz

¹Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA.

Journal for Healthcare Quality : Official Publication of the National Association for Healthcare Quality

|December 5, 2009

Summary

Implementing a STEMI Code protocol significantly improved door-to-balloon times for ST-elevation myocardial infarction (STEMI) patients receiving percutaneous coronary intervention (PCI). This protocol reduced disparities in care between weekdays and weekends.

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Published on: January 15, 2017

Area of Science:

Cardiology
Emergency Medicine
Health Systems Research

Background:

Primary percutaneous coronary intervention (PCI) is the standard treatment for ST-elevation myocardial infarction (STEMI).
Door-to-balloon (DTB) times for STEMI patients often exceed the recommended 90 minutes, impacting outcomes.
Significant disparities exist in DTB times between weekday and weekend STEMI care.

Purpose of the Study:

To evaluate the impact of a STEMI Code protocol on DTB times.
To assess whether the protocol reduced disparities in PCI delivery between weekdays and weekends.

Main Methods:

A retrospective review of STEMI cases before and after STEMI Code protocol implementation.
Analysis of door-to-balloon times for patients receiving primary PCI.
Comparison of DTB times based on weekday versus weekend presentation.

Main Results:

The STEMI Code protocol led to a threefold increase in patients receiving PCI within 90 minutes (p<.0001).
Pre-protocol, only 27.1% of weekday and 6.3% of weekend STEMI cases met the 90-minute DTB goal.
Post-protocol, DTB times significantly improved, equalizing weekday and weekend care.

Conclusions:

A STEMI Code protocol is highly effective in improving DTB times for STEMI patients.
The protocol successfully mitigated disparities in timely PCI access between weekdays and weekends.
Implementation of such protocols is crucial for optimizing STEMI management and patient outcomes.