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Sustaining improvement in door-to-balloon time over 4 years: the Mayo clinic ST-elevation myocardial infarction

David M Nestler1, Amit Noheria, Luis H Haro

  • 1Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA. nestler.david@mayo.edu

Circulation. Cardiovascular Quality and Outcomes
|December 25, 2009
PubMed

Insights

Implementing the Mayo Clinic STEMI protocol significantly reduced door-to-balloon times for ST-elevation myocardial infarction patients. This improvement in primary percutaneous coronary intervention timeliness was sustained over four years.

Area of Science:

  • Cardiology
  • Healthcare Systems Engineering

Background:

  • Guidelines recommend door-to-balloon (DTB) times <90 minutes for ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention.
  • Sustained DTB performance systems of care have not been previously reported.

Purpose of the Study:

  • To report on systems of care to achieve and sustain DTB performance over several years.
  • To evaluate the effectiveness and durability of the Mayo Clinic STEMI protocol.

Main Methods:

  • Implemented a STEMI protocol including physician activation, single call system, rapid staff response, and real-time feedback.
  • Collected data on nontransferred STEMI patients pre- and post-protocol implementation.
  • Analyzed DTB times for 96 patients pre-implementation and 322 patients post-implementation over a 4-year period.

Main Results:

  • Median DTB decreased from 97 minutes pre-implementation to 67 minutes post-implementation (P<0.001).
  • The percentage of patients with DTB <90 minutes increased from 40% to 81%.
  • DTB performance remained stable over the 4-year follow-up (P=0.41).

Conclusions:

  • The Mayo Clinic STEMI protocol effectively reduced DTB times for STEMI patients.
  • The protocol demonstrated sustained effectiveness over a 4-year period.
  • Process changes targeting primary percutaneous coronary intervention timeliness are effective and durable.
Abstract

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