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Systems of Care to Improve Timeliness of Reperfusion Therapy for ST-Segment Elevation Myocardial Infarction During Off Hours

The Mayo Clinic STEMI Protocol

Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.

^_* Reprint requests and correspondence: Dr. Henry H. Ting, Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905. (Email: ting.henry{at}mayo.edu).

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 Marys 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 Marys 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 Marys Hospital was 85 min during regular hours and 98 min during off hours.

Results: Among 258 patients who presented to Saint Marys 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.

Abbreviations and Acronyms   CABG = coronary artery bypass graft   CHF = congestive heart failure   IQR = interquartile range   MI = myocardial infarction   PCI = percutaneous coronary intervention   STEMI = ST-segment elevation myocardial infarction