Factors affecting STEMI performance in six hospitals within one healthcare system

Background: How quickly percutaneous coronary intervention is performed in patients with ST-elevation myocardial infarction (STEMI) is a quality measure, reported as door-to-balloon (D2B) time. Objectives: To explore factors affecting STEMI performance in six hospitals in one healthcare system. Methods: This was a retrospective chart review of clinical features and D2B times. Predictors for D2B times were identified using multivariate linear regression. Results: The median D2B time for all six hospitals was 63 minutes and all hospitals surpassed the minimal recommended percentage of patients achieving D2B time <= 90 minutes (87.8%vs75%,p<0.001). Patient confounders adversely affect D2B times (+21.5 minutes, p<0.001). Field ECG/activation with emergency department (ED) transport (-22.0 minutes) or direct cardiac catheterization laboratory (CCL) transport (-27.3 minutes) was superior to ED ECG/activation (p<0.001). Conclusion: Field ECG/STEMI activation significantly shortened D2B time. To improve D2B time, hospital and Emergency Medical Service collaboration should be advocated to increase field activation and direct patient transportation to CCL. (C) 2021 Elsevier Inc. All rights reserved.