Regional systems of care to optimize timeliness of reperfusion therapy for ST-elevation myocardial infarction

The Mayo Clinic STEMI protocol

Henry H. Ting, Charanjit Rihal, Bernard J. Gersh, Luis H. Haro, Christine M. Bjerke, Ryan J. Lennon, Choon Chern Lim, John F. Bresnahan, Allan S Jaffe, David Holmes, Malcolm R. Bell

Research output: Contribution to journalArticle

253 Citations (Scopus)

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 >3 hours and then were transferred for primary PCI (group B), and 131 patients who presented to a regional hospital with symptom onset <3 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 <90 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 <30 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.

Original languageEnglish (US)
Pages (from-to)729-736
Number of pages8
JournalCirculation
Volume116
Issue number7
DOIs
StatePublished - Aug 2007

Fingerprint

Reperfusion
Percutaneous Coronary Intervention
Therapeutics
Needles
ST Elevation Myocardial Infarction
Thrombolytic Therapy
Quality Improvement

Keywords

  • Angina
  • Angioplasty
  • Myocardial infarction

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Regional systems of care to optimize timeliness of reperfusion therapy for ST-elevation myocardial infarction : The Mayo Clinic STEMI protocol. / Ting, Henry H.; Rihal, Charanjit; Gersh, Bernard J.; Haro, Luis H.; Bjerke, Christine M.; Lennon, Ryan J.; Lim, Choon Chern; Bresnahan, John F.; Jaffe, Allan S; Holmes, David; Bell, Malcolm R.

In: Circulation, Vol. 116, No. 7, 08.2007, p. 729-736.

Research output: Contribution to journalArticle

Ting, Henry H. ; Rihal, Charanjit ; Gersh, Bernard J. ; Haro, Luis H. ; Bjerke, Christine M. ; Lennon, Ryan J. ; Lim, Choon Chern ; Bresnahan, John F. ; Jaffe, Allan S ; Holmes, David ; Bell, Malcolm R. / Regional systems of care to optimize timeliness of reperfusion therapy for ST-elevation myocardial infarction : The Mayo Clinic STEMI protocol. In: Circulation. 2007 ; Vol. 116, No. 7. pp. 729-736.
@article{cee17b8dcc7442adbc1720061d37f578,
title = "Regional systems of care to optimize timeliness of reperfusion therapy for ST-elevation myocardial infarction: The Mayo Clinic STEMI protocol",
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 >3 hours and then were transferred for primary PCI (group B), and 131 patients who presented to a regional hospital with symptom onset <3 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 <90 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 <30 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.",
keywords = "Angina, Angioplasty, Myocardial infarction",
author = "Ting, {Henry H.} and Charanjit Rihal and Gersh, {Bernard J.} and Haro, {Luis H.} and Bjerke, {Christine M.} and Lennon, {Ryan J.} and Lim, {Choon Chern} and Bresnahan, {John F.} and Jaffe, {Allan S} and David Holmes and Bell, {Malcolm R.}",
year = "2007",
month = "8",
doi = "10.1161/CIRCULATIONAHA.107.699934",
language = "English (US)",
volume = "116",
pages = "729--736",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "7",

}

TY - JOUR

T1 - Regional systems of care to optimize timeliness of reperfusion therapy for ST-elevation myocardial infarction

T2 - The Mayo Clinic STEMI protocol

AU - Ting, Henry H.

AU - Rihal, Charanjit

AU - Gersh, Bernard J.

AU - Haro, Luis H.

AU - Bjerke, Christine M.

AU - Lennon, Ryan J.

AU - Lim, Choon Chern

AU - Bresnahan, John F.

AU - Jaffe, Allan S

AU - Holmes, David

AU - Bell, Malcolm R.

PY - 2007/8

Y1 - 2007/8

N2 - 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 >3 hours and then were transferred for primary PCI (group B), and 131 patients who presented to a regional hospital with symptom onset <3 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 <90 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 <30 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.

AB - 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 >3 hours and then were transferred for primary PCI (group B), and 131 patients who presented to a regional hospital with symptom onset <3 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 <90 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 <30 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.

KW - Angina

KW - Angioplasty

KW - Myocardial infarction

UR - http://www.scopus.com/inward/record.url?scp=34547911049&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34547911049&partnerID=8YFLogxK

U2 - 10.1161/CIRCULATIONAHA.107.699934

DO - 10.1161/CIRCULATIONAHA.107.699934

M3 - Article

VL - 116

SP - 729

EP - 736

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 7

ER -