Regional Systems of Care to Optimize Timeliness of Reperfusion Therapy for ST-Elevation Myocardial Infarction

Abstract

Background-Quality improvement efforts have focused on strategies to improve the timeliness of reperfusion therapy in ST-elevation myocardial infarction patients who present to hospitals with and without percutaneous coronary intervention (PCI) capability. We implemented and evaluated a protocol to optimize the timeliness of reperfusion therapy and to coordinate systems of care for a PCI center and 28 regional hospitals located up to 150 miles away across 3 states. Methods and Results-The present study focused on a prospective, observational cohort of 597 patients who presented with ST-segment elevation and within 12 hours of symptom onset to Saint Marys Hospital and 28 regional hospitals up to 150 miles away between May 2004 and December 2006. The Mayo Clinic ST-elevation myocardial infarction protocol implemented strategies to improve timeliness of reperfusion therapy and to coordinate systems of care for transfer between hospitals. The study sample consisted of 258 patients who presented to Saint Marys Hospital and were treated with primary PCI (group A), 105 patients who presented to a regional hospital with symptom onset Ͼ3 hours and then were transferred for primary PCI (group B), and 131 patients who presented to a regional hospital with symptom onset Ͻ3 hours and were treated with full-dose fibrinolytic therapy (group C). For groups A and B, median door-to-balloon times were 71 and 116 minutes, respectively. Door-to-balloon time Ͻ90 minutes was achieved in 75% of group A and 12% of group B. Median door-to-needle time was 25 minutes for group C, and 70% had door-to-needle time Ͻ30 minutes. Conclusions-The Mayo Clinic ST-elevation myocardial infarction protocol demonstrates the feasibility of implementing strategies to optimize the timeliness of reperfusion therapy and the times that can be achieved through coordinated systems of care for ST-elevation myocardial infarction patients presenting to a PCI center (Saint Marys Hospital) and 28 regional hospitals without PCI capability located up to 150 miles away across 3 states. (Circulation. 2007;116:729-736.)

Acute myocardial infarction system of care in the third world

“…For example, models of STEMI systems of care include that in Vienna with its city-wide system of care [10], France with the famous SAMU-nationwide system [11], Minneapolis [12] and Mayo clinic [13] with their regional system of care. Although they have some differences in the protocol, all of the systems are using a pharmaco-invasive approach.…”

Providing optimal regional care for ST-segment elevation myocardial infarction: a prospective cohort study of patients in the Hamilton Niagara Haldimand Brant Local Health Integration Network

“…10,13,14,[16][17][18][19] Our data suggest that even where best practices for regional STEMI care are implemented, some patients may still require fibrinolysis. The presented regression model is consistent with the accepted paradigm that time to reperfusion is an important predictor of STEMI outcomes.…”

Regional cardiac resuscitation systems of care

“…But few communities have achieved sustained improvements in survival after cardiac resuscitation. (7)(8)(9) In contrast to this lack of improvement in survival over time, implementation of regional systems of care for those with traumatic injury (10) and acute myocardial infarction (AMI) (11)(12)(13) improved outcomes for patients with these conditions. Therefore development and implementation of cardiac resuscitation systems of care are recommended to try to achieve similar improvements in outcomes.…”