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Multicenter Study
. 2019 Jan 8;8(1):e008096.
doi: 10.1161/JAHA.118.008096.

Improving Care of STEMI in the United States 2008 to 2012

Christopher B Granger  1 , Eric R Bates  2 , James G Jollis  1 , Elliott M Antman  3 , Graham Nichol  4 , Robert E O'Connor  5 , Tammy Gregory  6 , Mayme L Roettig  1 , S Andrew Peng  7 , Gray Ellrodt  8 , Timothy D Henry  9 , William J French  10 , Alice K Jacobs  11
Affiliations
Multicenter Study

Improving Care of STEMI in the United States 2008 to 2012

Christopher B Granger et al. J Am Heart Assoc. .

Abstract

Background We aimed to determine the change in treatment strategies and times to treatment over the first 5 years of the Mission: Lifeline program. Methods and Results We assessed pre- and in-hospital care and outcomes from 2008 to 2012 for patients with ST -segment-elevation myocardial infarction at US hospitals, using data from the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines Registry. In-hospital adjusted mortality was calculated including and excluding cardiac arrest as a reason for primary percutaneous coronary intervention delay. A total of 147 466 patients from 485 hospitals were analyzed. There was a decrease in the proportion of eligible patients not treated with reperfusion (6.2% versus 3.3%) and treated with fibrinolytic therapy (13.4% versus 7.0%). Median time from symptom onset to first medical contact was unchanged (≈50 minutes). Use of prehospital ECGs increased (45% versus 71%). All major reperfusion times improved: median first medical contact-to-device for emergency medical systems transport to percutaneous coronary intervention-capable hospitals (93 to 84 minutes), first door-to-device for transfers for primary percutaneous coronary intervention (130 to 112 minutes), and door-in-door-out at non-percutaneous coronary intervention-capable hospitals (76 to 62 minutes) (all P<0.001 over 5 years). Rates of cardiogenic shock and cardiac arrest, and overall in-hospital mortality increased (5.7% to 6.3%). Adjusted mortality excluding patients with known cardiac arrest decreased by 14% at 3 years and 25% at 5 years ( P<0.001). Conclusions Quality of care for patients with ST -segment-elevation myocardial infarction improved over time in Mission: Lifeline, including increased use of reperfusion therapy and faster times-to-treatment. In-hospital mortality improved for patients without cardiac arrest but did not appear to improve overall as the number of these high-risk patients increased.

Keywords: ST‐segment elevation myocardial infarction; fibrinolytic therapy; primary percutaneous coronary intervention; reperfusion.

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Figures

Figure 1
Figure 1
Mission: Lifeline STEMI systems United States national coverage as of November 29, 2012. STEMI indicates ST‐segment–elevation myocardial infarction.
Figure 2
Figure 2
Yearly in‐hospital mortality, crude and excluding reported cardiac arrest, 2008‐2012.
Figure 3
Figure 3
In‐hospital mortality, yearly adjusted odds ratio vs 2008. CI indicates confidence interval; ref, reference value.
See this image and copyright information in PMC

Comment in

References

    1. Fibrinolytic Therapy Trialists’ (FTT) Collaborative Group . Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Lancet. 1994;343:311–322. - PubMed
    1. Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet. 2003;361:13–20. - PubMed
    1. Jacobs AK, Antman EM, Faxon DP, Gregory T, Solis P. Development of systems of care for ST‐elevation myocardial infarction patients: executive summary. Circulation. 2007;116:217–230. - PubMed
    1. Jollis JG, Granger CB, Henry TD, Antman EM, Berger PB, Moyer PH, Pratt FD, Rokos IC, Acuña AR, Roettig ML, Jacobs AK. Systems of care for ST‐segment‐elevation myocardial infarction: a report from the American Heart Association's Mission: Lifeline. Circ Cardiovasc Qual Outcomes. 2012;5:423–428. - PubMed
    1. American Heart Association . Mission: Lifeline website. Available at: http://www.heart.org/HEARTORG/HealthcareResearch/MissionLifelineHomePage.... Accessed April 4, 2017.

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