Catheterization Laboratory Activation Time in Patients Transferred With ST-Segment-Elevation Myocardial Infarction:
Michel Zeitouni1, Hussein R Al-Khalidi1, Mayme L Roettig1
1Duke Clinical Research Institute, Durham, NC (M.Z., H.R.A.-K., M.L.R., S.M.D., A.S.H., L.M., C.B.G.).
Circulation. Cardiovascular Quality and Outcomes
|June 27, 2020
Summary
Faster catheterization laboratory activation for ST-segment-elevation myocardial infarction patients significantly improves reperfusion times. Timely activation ensures more patients receive primary percutaneous coronary intervention within national goals, enhancing treatment efficiency.
Area of Science:
- Cardiology
- Health Services Research
Background:
- Catheterization laboratory (cath lab) activation time is a new metric for ST-segment-elevation myocardial infarction (STEMI) patients needing inter-hospital transfer for primary percutaneous coronary intervention (PCI).
- This metric assesses inter-facility communication and the rapid mobilization of cardiac catheterization laboratory resources.
Purpose of the Study:
- To evaluate if faster cath lab activation correlates with improved reperfusion times and patient outcomes.
- To analyze data from the American Heart Association Mission: Lifeline Accelerator-2 Project.
Main Methods:
- A retrospective analysis of 2063 STEMI patients undergoing inter-hospital transfer for primary PCI across 12 US regions (April 2015-March 2017).
- Patients were stratified based on cath lab activation time: timely (≤20 minutes) versus delayed (>20 minutes).
- Factors influencing delayed activation and their impact on door-in door-out times and reperfusion times were assessed.
Main Results:
- The median cath lab activation time was 26 minutes; 60.2% of patients experienced delayed activation.
- Factors associated with delayed activation included prior cardiovascular/cerebrovascular disease, hypotension, and Black or Latino ethnicity.
- Timely activation was linked to shorter door-in door-out times (40 vs. 68 minutes) and reperfusion times (98 vs. 135 minutes).
- 80.1% of patients with timely activation received primary PCI within the 120-minute goal, compared to 39.0% with delayed activation.
Conclusions:
- Achieving cath lab activation within 20 minutes enabled primary PCI within the 120-minute goal for over 75% of patients across diverse hospitals.
- Despite confounding factors, cath lab activation time serves as a valuable process measure to guide resource allocation and improve timely STEMI treatment for transferred patients.
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