Implementing a comprehensive STEMI protocol to improve care metrics and outcomes in patients with in-hospital STEMI:
Christopher N Kanaan1, Nicholas Kassis2, Raunak M Nair3
1Cardiovascular Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA.
Insights
A comprehensive protocol improved care for patients with in-hospital ST-segment elevation myocardial infarction (iSTEMI). This quality initiative significantly reduced diagnosis-to-treatment times, enhancing care for this high-risk group.
Area of Science:
- Cardiology
- Healthcare Quality Improvement
- Clinical Interventions
Background:
- In-hospital ST-segment elevation myocardial infarction (iSTEMI) patients face high mortality risks due to diagnostic and treatment delays.
- There is a critical need for quality improvement initiatives targeting this vulnerable iSTEMI population.
Purpose of the Study:
- To evaluate the impact of a Comprehensive ST-segment Elevation Myocardial Infarction Protocol (CSP) on patient care and outcomes.
- To assess key performance metrics and clinical outcomes before and after CSP implementation in iSTEMI patients.
Main Methods:
- A single-center study analyzed 125 consecutive iSTEMI patients treated with percutaneous coronary intervention (PCI) from 2011 to 2019.
- A CSP was implemented in 2014, featuring standardized activation criteria, improved ECG access, checklists, 24/7 lab readiness, and a radial-first PCI approach.
Main Results:
- Median ECG-to-first-device activation time decreased significantly from 113 to 64 minutes post-CSP (p<0.001).
- Goal activation time adherence improved from 36% to 76% (p<0.001), and guideline-directed medical therapy administration pre-PCI increased from 27.3% to 65.4% (p<0.001).
- Trans-radial access increased from 16% to 70% (p<0.001), and home discharge rates rose from 56.8% to 76.5% (p=0.04).
Conclusions:
- Implementation of the CSP led to significant improvements in critical care metrics for iSTEMI patients.
- The CSP effectively reduced ECG-to-device activation times, benefiting a high-risk patient cohort.
Background:
Patients who experience in-hospital ST-segment elevation myocardial infarction (iSTEMI) represent a uniquely high-risk cohort owing to delays in diagnosis, prolonged time to reperfusion and increased mortality. Quality initiatives aimed at improving the care of this vulnerable, yet understudied population are needed.
Methods:
This study included consecutive patients with iSTEMI treated with percutaneous coronary intervention (PCI) between 1 January 2011 and 15 July 2019 at a single, tertiary referral centre. A comprehensive iSTEMI protocol (CSP) was implemented on 15 July 2014, incorporating: (1) cardiology fellow activation of the catheterisation lab using standardised criteria, (2) nursing chest pain protocol, (3) improved electronic access to electrocardiographic studies, (4) checklist for initial triage and management, (5) 24/7/365 catheterisation lab readiness and (6) radial-first PCI approach. Key metrics and clinical outcomes were compared before and after CSP implementation.
Results:
Among 125 total subjects, the post-CSP cohort (n=81) was younger, had more males and were more likely to be hospitalised for cardiac-related reasons relative to the pre-CSP cohort (n=44) who were more likely hospitalised for operative-related aetiologies. After CSP adoption, median ECG-to-first-device-activation time decreased from 113 min to 64 min (p<0.001), goal ECG-to-first-device-activation time increased from 36% to 76% of patients (p<0.001), administration of guideline-directed medical therapy prior to PCI increased from 27.3% to 65.4% (p<0.001), trans-radial access increased from 16% to 70% (p<0.001) and rates of discharge home increased from 56.8% to 76.5% (p=0.04). Statistically insignificant numerical reductions were observed post-CSP in in-hospital mortality (18.2% vs 9.9%, p=0.30), 30-day mortality (15.9% vs 12.3%, p=0.78) and 1-year mortality (27.3% vs 21.0%, p=0.57).
Conclusions:
The implementation of a CSP was associated with marked enhancements in key care metrics among patients with iSTEMI. Among a larger cohort, the use of a CSP yielded a significant reduction in ECG-to-first-device-activation time in a particularly vulnerable population at high risk of death.
More Related Videos
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
09:21Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:26Acute Coronary Syndrome V: Nursing Management
01:27Coronary Artery Disease V: Interprofessional Care
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care