Treatment Time and In-Hospital Mortality Among Patients With ST-Segment Elevation Myocardial Infarction, 2018-2021
James G Jollis1,2, Christopher B Granger2, Jessica K Zègre-Hemsey3
1Lindner Center for Research and Education, Cincinnati, Ohio.
JAMA
|November 6, 2022
Summary
Timely treatment for ST-elevation myocardial infarction (STEMI) significantly reduces in-hospital mortality. However, most hospitals did not meet treatment time goals between 2018 and 2021, particularly for inter-hospital transfers.
Area of Science:
- Cardiology
- Public Health
Background:
- US national guidelines recommend time-sensitive treatment for ST-segment elevation myocardial infarction (STEMI) to minimize myocardial injury.
- Adherence to these treatment-time goals is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate process measures and outcomes for STEMI patients within a national registry.
- To assess adherence to recommended treatment times and their association with in-hospital mortality.
Main Methods:
- A cross-sectional study analyzed data from 114,871 STEMI patients from the Get With The Guidelines-Coronary Artery Disease registry (Q2 2018-Q3 2021).
- Key metrics included treatment times, in-hospital mortality, and adherence to system goals (e.g., PCI within 90 or 120 minutes).
Main Results:
- Median time to percutaneous coronary intervention (PCI) varied by presentation mode, with longer delays for transferred patients.
- Adjusted in-hospital mortality was significantly lower for patients treated within target times across all presentation modes.
- System goals were not met in most quarters, with only 17% of transferred patients treated within 120 minutes.
Conclusions:
- Timely STEMI treatment is associated with reduced in-hospital mortality.
- Despite established guidelines, adherence to treatment-time goals remains suboptimal, especially for inter-hospital transfers.
- Further improvements in system performance are needed to consistently meet STEMI treatment targets.
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