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. 2022 Nov 22;328(20):2033-2040.
doi: 10.1001/jama.2022.20149.

Treatment Time and In-Hospital Mortality Among Patients With ST-Segment Elevation Myocardial Infarction, 2018-2021

James G Jollis  1   2 , Christopher B Granger  2 , Jessica K Zègre-Hemsey  3 , Timothy D Henry  1 , Abhinav Goyal  4 , Jacqueline E Tamis-Holland  5 , Mayme Lou Roettig  2 , Murtuza J Ali  6 , William J French  7 , Ram Poudel  8 , Juan Zhao  8 , R Harper Stone  9 , Alice K Jacobs  10
Affiliations

Treatment Time and In-Hospital Mortality Among Patients With ST-Segment Elevation Myocardial Infarction, 2018-2021

James G Jollis et al. JAMA. .

Abstract

Importance: Recognizing the association between timely treatment and less myocardial injury for patients with ST-segment elevation myocardial infarction (STEMI), US national guidelines recommend specific treatment-time goals.

Objective: To describe these process measures and outcomes for a recent cohort of patients.

Design, setting, and participants: Cross-sectional study of a diagnosis-based registry between the second quarter of 2018 and the third quarter of 2021 for 114 871 patients with STEMI treated at 648 hospitals in the Get With The Guidelines-Coronary Artery Disease registry.

Exposures: STEMI or STEMI equivalent.

Main outcomes and measures: Treatment times, in-hospital mortality, and adherence to system goals (75% treated ≤90 minutes of first medical contact if the first hospital is percutaneous coronary intervention [PCI]-capable and ≤120 minutes if patients require transfer to a PCI-capable hospital).

Results: In the study population, median age was 63 (IQR, 54-72) years, 71% were men, and 29% were women. Median time from symptom onset to PCI was 148 minutes (IQR, 111-226) for patients presenting to PCI-capable hospitals by emergency medical service, 195 minutes (IQR, 127-349) for patients walking in, and 240 minutes (IQR, 166-402) for patients transferred from another hospital. Adjusted in-hospital mortality was lower for those treated within target times vs beyond time goals for patients transported via emergency medical services (first medical contact to laboratory activation ≤20 minutes [in-hospital mortality, 3.6 vs 9.2] adjusted OR, 0.54 [95% CI, 0.48-0.60], and first medical contact to device ≤90 minutes [in-hospital mortality, 3.3 vs 12.1] adjusted OR, 0.40 [95% CI, 0.36-0.44]), walk-in patients (hospital arrival to device ≤90 minutes [in-hospital mortality, 1.8 vs 4.7] adjusted OR, 0.47 [95% CI, 0.40-0.55]), and transferred patients (door-in to door-out time <30 minutes [in-hospital mortality, 2.9 vs 6.4] adjusted OR, 0.51 [95% CI, 0.32-0.78], and first hospital arrival to device ≤120 minutes [in-hospital mortality, 4.3 vs 14.2] adjusted OR, 0.44 [95% CI, 0.26-0.71]). Regardless of mode of presentation, system goals were not met in most quarters, with the most delayed system performance among patients requiring interhospital transfer (17% treated ≤120 minutes).

Conclusions and relevance: This study of patients with STEMI included in a US national registry provides information on changes in process and outcomes between 2018 and 2021.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Jollis reported consulting for Genentech. Dr Granger reported research grants from Akros, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, Janssen, Pfizer, Armetheon, US Food and Drug Administration, GlaxoSmithKline, The Medicines Company, Medtronic Foundation, Medtronic, and Novartis; and consulting fees from Abiomed, Alnylam Pharma, Anthos, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, Cardionomic, Celecor Therapeutics, Correvio, Daiichi Sankyo, Espero, Janssen, Pfizer, Philips, AbbVie, Armetheon, AstraZeneca, Eli Lilly, Gilead, GlaxoSmithKline, HengRui, Hoffmann-La Roche, The Medicines Company, National Institutes of Health, Novartis, Sirtex, Reata, Verseon, Apple, Medscape, Medtronic, Merck, Novo Nordisk, Roche Diagnostics, Rho Pharmaceuticals, and Tenac.io. Dr Tamis-Holland reported being on the American Heart Association (AHA) Systems of Care Committee and volunteer partticipation on the executive leadership committee for New York City Systems of Care of ST-segment elevation myocardial infarction (STEMI) until approximately 2018, which received grant support (awarded to Duke University) to oversee work on improving systems of care for STEMI (no funding was given to Dr Tamis-Holland or to her organization). Dr Roettig reported receipt of personal fees from CeleCor Therapeutics for research consultation outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flowchart of Cohort Selection for Patients With STEMI or STEMI Equivalent on Electrogram
aRegistry refers to the Get With the Guidelines–Coronary Artery Disease registry. bMissing discharge status refers to patient death or discharged to home, hospice, or other health care facilities. STEMI indicates ST-segment elevation myocardial infarction.
Figure 2.
Figure 2.. Process Time Measures by Year, Quarter, and Mode of Presentation
The horizontal line in each box indicates the median, the top and bottom of the boxes indicate the IQR, and the whiskers indicate the absolute range. The horizontal lines indicate the quality initiative for time goals for treating 75% of patients. EMS indicates emergency medical services.
See this image and copyright information in PMC

Comment in

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