Process Factors Affecting Reperfusion Time in Patients With ST-Segment Elevation Myocardial Infarction

Area of Science:

• Cardiology
• Emergency Medicine
• Health Services Research

Background:

• ST-segment elevation myocardial infarction (STEMI) is a critical medical emergency.
• Delayed reperfusion in STEMI correlates with adverse patient outcomes.
• Minimizing time to treatment is crucial for STEMI patients.

Purpose of the Study:

• To identify process factors influencing reperfusion time in STEMI patients.
• To analyze predictors of door-to-balloon time in a real-world setting.
• To evaluate the impact of various clinical and logistical elements on STEMI treatment duration.

Main Methods:

• Multivariate regression analysis of admissions data from 618 STEMI patients in Las Vegas (2015-2017).
• Dependent variable: door-to-balloon time.
• Independent variables included mode of arrival, time of day, pre-hospital ECG, STEMI protocol activation, and various time intervals (e.g., door-to-triage, door-to-ECG).

Main Results:

• Pre-hospital STEMI activation, cardiologist arrival, lifesaving measures, door-to-ECG time, time/day, critical diagnostic exams, and door-to-first physician contact were significant predictors of door-to-balloon time (p < 0.05).
• Several previously suggested factors did not show statistically significant impact in this cohort.

Conclusions:

• Early identification of STEMI via ECG and prompt STEMI protocol activation are essential for reducing reperfusion times.
• Optimizing specific process factors can improve door-to-balloon times.
• Further research may be needed to validate the impact of all potential process factors on STEMI reperfusion.