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.).
Insights
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.
Background:
Catheterization laboratory (cath lab) activation time is a newly available process measure for patients with ST-segment-elevation myocardial infarction requiring inter-hospital transfers for primary percutaneous coronary intervention that reflects inter-facility communication and urgent mobilization of interventional laboratory resources. Our aim was to determine whether faster activation is associated with improved reperfusion time and outcomes in the American Heart Association Mission: Lifeline Accelerator-2 Project.
Methods And Results:
From April 2015 to March 2017, treatment times of 2063 patients with ST-segment-elevation myocardial infarction requiring inter-hospital transfer for primary percutaneous coronary intervention from 12 regions around the United States were stratified by cath lab activation time (first hospital arrival to cath lab activation within [timely] or beyond 20 minutes [delayed]). Median cath lab activation time was 26 minutes, with a delayed activation observed in 1241 (60.2%) patients. Prior cardiovascular or cerebrovascular disease, arterial hypotension at admission, and black or Latino ethnicity were independent factors of delayed cath lab activation. Timely cath lab activation patients had shorter door-in door-out times (40 versus 68 minutes) and reperfusion times (98 versus 135 minutes) with 80.1% treated within the national goal of ≤120 minutes versus 39.0% in the delayed group.
Conclusions:
Cath lab activation within 20 minutes across a geographically diverse group of hospitals was associated with performing primary percutaneous coronary intervention within the national goal of ≤120 minutes in >75% of patients. While several confounding factors were associated with delayed activation, this work suggests that this process measure has the potential to direct resources and practices to more timely treatment of patients requiring inter-hospital transfer for primary percutaneous coronary intervention.
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