ST-elevation myocardial infarction: which patients do quality assurance programs include?
Alex R Campbell1, Daniel Satran, David M Larson
1Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minn.
Insights
Quality assurance for ST-elevation myocardial infarction (STEMI) varies significantly between registries. Different inclusion criteria for STEMI patient data lead to inconsistent quality measurement outcomes.
Area of Science:
- Cardiology
- Health Services Research
- Quality Improvement
Background:
- Efforts to improve timely percutaneous coronary intervention (PCI) access for ST-elevation myocardial infarction (STEMI) are ongoing in the US.
- The Joint Commission (TJC) and the American College of Cardiology National Cardiovascular Data Registry (NCDR) have established standardized STEMI definitions and performance measures.
Purpose of the Study:
- To identify and analyze discrepancies among three distinct quality-assurance registries for STEMI patients.
- To evaluate the impact of varying inclusion criteria on quality measurement in STEMI care.
Main Methods:
- A retrospective analysis of consecutive STEMI patients treated under a regional Level 1 MI protocol over one year.
- Comparison of STEMI patient cohorts against inclusion criteria for NCDR and TJC registries.
- Analysis of patient characteristics, including transfer status and treatment modality (PCI, CABG, medical management).
Main Results:
- Of 501 STEMI patients, 282 met NCDR criteria (56%) and 66 met TJC criteria (13%).
- Transfer patients comprised 87% of the discrepancy between Level 1 and TJC registries.
- Pharmacoinvasive PCI accounted for 47% of the discrepancy between Level 1 and NCDR registries.
Conclusions:
- Current STEMI registry inclusion criteria lack uniformity.
- Non-uniform criteria can result in variable quality assurance outcomes for identical patient populations.
- Standardized quality measurement for STEMI care is challenged by these registry differences.
Background:
In the United States, efforts are underway to improve timely access to percutaneous coronary intervention in ST-elevation myocardial infarction (STEMI). The Joint Commission (TJC) and the American College of Cardiology National Cardiovascular Data Registry (NCDR) have developed standardized definitions and clinical performance measures for STEMI. The purpose of this study was to determine differences in 3 quality-assurance registries for STEMI patients.
Methods And Results:
STEMI patients presenting to the Minneapolis Heart Institute at Abbott Northwestern Hospital (Minneapolis, Minn) are tracked by 3 distinct quality assurance programs: NCDR, TJC, and the level 1 MI registry (a regional system for percutaneous coronary intervention in STEMI which includes transfer patients). Over 1 year, we examined consecutive STEMI patients in level 1 and compared them with individuals meeting NCDR and TJC inclusion criteria. Of 501 STEMI patients treated using the level 1 MI protocol, 422 patients had a clear culprit (402 percutaneous coronary intervention, 13 coronary artery bypass grafting, 7 medical management). In the same period, 282 patients met inclusion criteria for NCDR (56% of the level 1 population), and 66 met inclusion criteria for TJC (13% of the level 1 population). Transfer patients (n=380) accounted for 87% of the discrepancy between level 1 and TJC. Pharmacoinvasive percutaneous coronary intervention (n=102) accounted for 47% of the discrepancy between level 1 and NCDR.
Conclusions:
Current inclusion criteria for enrollment in STEMI registries are not uniform. This may lead to variable quality assurance outcomes for the same patient cohort and has important implications for standardized quality measurement.
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