Association of a Comprehensive ST-Segment-Elevation Myocardial Infarction Protocol With Key Process Metrics Among
Radoslav Zinoviev1, Anirudh Kumar2, Chetan P Huded3
1Division of Cardiology University of California Los Angeles Los Angeles CA USA.
Journal of the American Heart Association
|May 2, 2025
Summary
A new comprehensive STEMI protocol improved door-to-balloon times for heart attack patients. This led to better treatment and a reduced 30-day mortality rate, enhancing STEMI care.
Area of Science:
- Cardiology
- Emergency Medicine
- Healthcare Systems Improvement
Background:
- Most US ST-segment-elevation myocardial infarction (STEMI) patients transferred for percutaneous coronary intervention (PCI) do not meet the door-to-balloon time (D2BT) goal of ≤120 minutes.
- Timely reperfusion therapy is critical for STEMI outcomes.
- Existing protocols often fall short in optimizing STEMI care pathways.
Purpose of the Study:
- To evaluate the impact of a comprehensive STEMI protocol (CSP) on STEMI process metrics.
- To assess improvements in guideline-directed medical therapy, radial access, and D2BT.
- To determine the effect of the CSP on 30-day mortality rates in STEMI patients.
Main Methods:
- A 4-step CSP was implemented, including ED cardiac catheterization laboratory activation, a STEMI Safe Handoff Checklist, immediate transfer, and a radial-first approach to PCI.
- A comparative analysis was conducted on 1274 STEMI patients transferred for PCI, divided into pre-CSP (n=499) and CSP (n=775) groups.
- Key metrics including medical therapy use, access site, D2BT, and 30-day mortality were analyzed before and after CSP implementation.
Main Results:
- Guideline-directed medical therapy use increased from 84.6% to 93.9% (P<0.001).
- Radial access significantly increased from 19.0% to 77.7% (P<0.001).
- Median D2BT decreased from 114 to 97 minutes (P<0.001), with 80.1% of patients achieving D2BT ≤120 minutes post-CSP, compared to 55.7% pre-CSP.
Conclusions:
- The comprehensive STEMI protocol significantly improved key process metrics for STEMI patients.
- Implementation of the CSP was associated with a substantial reduction in door-to-balloon times.
- Achieving D2BT <120 minutes correlated with a 50% relative risk reduction in 30-day mortality.
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