Systems of care to improve timeliness of reperfusion therapy for ST-segment elevation myocardial infarction during off hours: the Mayo Clinic STEMI protocol

David R Holmes, Malcolm R Bell, Bernard J Gersh, Charanjit S Rihal, Luis H Haro, Christine M Bjerke, Ryan J Lennon, Choon-Chern Lim, Henry H Ting
JACC. Cardiovascular Interventions 2008, 1 (1): 88-96

OBJECTIVES: We implemented the Mayo Clinic ST-segment elevation myocardial infarction (STEMI) protocol and evaluated the timeliness of reperfusion therapy during off hours versus regular hours.

BACKGROUND: Patients with STEMI who present during off hours have longer door-to-balloon times and door-to-needle times.

METHODS: The Mayo STEMI protocol was implemented in May 2004 to optimize timeliness of reperfusion therapy for STEMI patients presenting to Saint Mary's Hospital, a tertiary facility with on-site percutaneous coronary intervention (PCI), and for those presenting to 28 regional hospitals located up to 150 miles away from Saint Mary's Hospital. We compared door-to-balloon times and door-to-needle times for 597 consecutive patients who presented during off hours (weekdays from 5 pm to 7 am and any time on weekends or holidays) versus regular hours (weekdays from 7 am to 5 pm). In 2003, prior to implementing the protocol, median door-to-balloon time at Saint Mary's Hospital was 85 min during regular hours and 98 min during off hours.

RESULTS: Among 258 patients who presented to Saint Mary's Hospital, median door-to-balloon time was 65 min during regular hours versus 74 min during off hours (p = 0.085). Among 105 patients transferred from regional hospitals for primary PCI, median door-to-balloon time was 118 min during regular hours versus 114 min during off hours (p = 0.15). Among 131 patients treated with fibrinolytic therapy at regional hospitals, median door-to-needle time was 21 min during regular hours versus 26 min during off hours (p = 0.067).

CONCLUSIONS: The Mayo Clinic STEMI protocol demonstrates the rapid times that can be achieved through coordinated systems of care for STEMI patients presenting during off hours and regular hours.

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