Zinoviev Radoslav, Kumar Anirudh, Huded Chetan P, Johnson Michael, Kravitz Kathleen, Reed Grant W, Krishnaswamy Amar, Kralovic Damon Michael, Hustey Fredric M, Brown Abigail S, Kapadia Samir R, Khot Umesh N
Division of Cardiology University of California Los Angeles Los Angeles CA USA.
Northwestern Central DuPage Hospital Winfield IL USA.
J Am Heart Assoc. 2025 May 6;14(9):e034054. doi: 10.1161/JAHA.123.034054. Epub 2025 May 2.
Most US patients with ST-segment-elevation myocardial infarction (STEMI) transferred for percutaneous coronary intervention (PCI) do not achieve the goal door-to-balloon time (D2BT) of ≤120 minutes. We evaluated the impact of a comprehensive STEMI protocol (CSP) implemented in our health care system on STEMI process metrics in patients transferred for PCI.
The CSP is a 4-step protocol including (1) emergency department (ED) cardiac catheterization laboratory activation; (2) a STEMI Safe Handoff Checklist; (3) immediate transfer to an available cardiac catheterization laboratory; and (4) radial-first approach to PCI. We compared the use of guideline-directed medical therapy before angiography, radial-first access, and D2BT in 1274 consecutive patients with STEMI transferred to our hospital for PCI before (pre-CSP group; January 1, 2011, to July 14, 2014) and after (CSP group; July 15, 2014, to July 15, 2019) CSP implementation. The study population included 499 patients in the pre-CSP group and 775 patients in the CSP group. After CSP implementation, guideline-directed medical therapy before angiography (84.6% versus 93.9%, <0.001) and radial access (19.0% versus 77.7%, <0.001) both increased significantly. Median D2BT decreased from 114 (interquartile range, 94-146 minutes) to 97 minutes (interquartile range, 82-115 minutes; <0.001) after CSP implementation, with substantially more patients treated with D2BT of ≤120 minutes (55.7% versus 80.1%, <0.001). Achievement of D2BT <120 minutes in the CSP group was associated with a 50% relative risk reduction in the 30-day mortality rate (odds ratio, 0.50; =0.04) and an absolute risk reduction of 0.7%.
In patients with STEMI transferred for PCI, a standardized protocol for STEMI care was associated in improvements in key process metrics (guideline-directed medical therapy, radial access, and D2BT) with associated reduction in the 30-day mortality rate.
大多数因接受经皮冠状动脉介入治疗（PCI）而转诊的美国ST段抬高型心肌梗死（STEMI）患者未达到门球囊扩张时间（D2BT）≤120分钟的目标。我们评估了在我们的医疗保健系统中实施的综合STEMI方案（CSP）对因PCI转诊患者的STEMI流程指标的影响。
CSP是一个包含4个步骤的方案，包括（1）急诊科（ED）心脏导管实验室激活；（2）STEMI安全交接检查表；（3）立即转至可用的心脏导管实验室；以及（4）PCI桡动脉优先入路。我们比较了在CSP实施之前（CSP前组；2011年1月1日至2014年7月14日）和之后（CSP组；2014年7月15日至2019年7月15日）转诊至我院接受PCI的1274例连续STEMI患者在血管造影前使用指南指导的药物治疗、桡动脉优先入路和D2BT的情况。研究人群包括CSP前组的499例患者和CSP组的775例患者。CSP实施后，血管造影前使用指南指导的药物治疗（84.6%对93.9%，<0.001）和桡动脉入路（19.0%对77.7%，<0.001）均显著增加。CSP实施后，D2BT中位数从114分钟（四分位间距，94 - 146分钟）降至97分钟（四分位间距，82 - 115分钟；<0.001），D2BT≤120分钟接受治疗的患者显著增多（55.7%对80.1%，<0.001）。CSP组D2BT<120分钟与30天死亡率相对风险降低50%（比值比，0.50；=0.04）和绝对风险降低0.7%相关。结论：在因PCI转诊的STEMI患者中，标准化的STEMI护理方案与关键流程指标（指南指导的药物治疗、桡动脉入路和D2BT）的改善相关，并伴有30天死亡率的降低。
