Published Online
on August 1, 2007

A more recent version of this article appeared on August 14, 2007

This Article Free upon publication Full Text (PDF) All Versions of this Article: 116/7/729    most recent CIRCULATIONAHA.107.699934v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ting, H. H. Articles by Bell, M. R. Search for Related Content PubMed PubMed Citation Articles by Ting, H. H. Articles by Bell, M. R. Pubmed/NCBI databases Medline Plus Health Information Angioplasty Heart Attack

Submitted on March 2, 2007
Accepted on May 29, 2007

Regional Systems of Care to Optimize Timeliness of Reperfusion Therapy for ST-Elevation Myocardial Infarction. The Mayo Clinic STEMI Protocol

Henry H. Ting MD, MBA^*, Charanjit S. Rihal MD, MBA, Bernard J. Gersh MB, ChB, DPhil, Luis H. Haro MD, Christine M. Bjerke RN, Ryan J. Lennon MS, Choon-Chern Lim BS, John F. Bresnahan MD, Allan S. Jaffe MD, David R. Holmes MD, and Malcolm R. Bell MB, BS

From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn.

^* To whom correspondence should be addressed. E-mail: ting.henry{at}mayo.edu.

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.

Key words: angioplasty • angina • myocardial infarction

This article has been cited by other articles:

				G. Nichol, E. Thomas, C. W. Callaway, J. Hedges, J. L. Powell, T. P. Aufderheide, T. Rea, R. Lowe, T. Brown, J. Dreyer, et al. Regional Variation in Out-of-Hospital Cardiac Arrest Incidence and Outcome JAMA, September 24, 2008; 300(12): 1423 - 1431. [Abstract] [Full Text] [PDF]

				H. H. Ting, H. M. Krumholz, E. H. Bradley, D. C. Cone, J. P. Curtis, B. J. Drew, J. M. Field, W. J. French, W. B. Gibler, D. C. Goff, et al. Implementation and Integration of Prehospital ECGs Into Systems of Care for Acute Coronary Syndrome: A Scientific Statement From the American Heart Association Interdisciplinary Council on Quality of Care and Outcomes Research, Emergency Cardiovascular Care Committee, Council on Cardiovascular Nursing, and Council on Clinical Cardiology Circulation, September 2, 2008; 118(10): 1066 - 1079. [Full Text] [PDF]

				G. W. Stone Angioplasty Strategies in ST-Segment-Elevation Myocardial Infarction: Part I: Primary Percutaneous Coronary Intervention Circulation, July 29, 2008; 118(5): 538 - 551. [Full Text] [PDF]

				G. W. Stone Angioplasty Strategies in ST-Segment-Elevation Myocardial Infarction: Part II: Intervention After Fibrinolytic Therapy, Integrated Treatment Recommendations, and Future Directions Circulation, July 29, 2008; 118(5): 552 - 566. [Full Text] [PDF]

				E. R. Bates and B. K. Nallamothu Commentary: The Role of Percutaneous Coronary Intervention in ST-Segment-Elevation Myocardial Infarction Circulation, July 29, 2008; 118(5): 567 - 573. [Full Text] [PDF]

				A. Manari, P. Ortolani, P. Guastaroba, G. Casella, L. Vignali, E. Varani, G. Piovaccari, V. Guiducci, G. Percoco, S. Tondi, et al. Clinical impact of an inter-hospital transfer strategy in patients with ST-elevation myocardial infarction undergoing primary angioplasty: the Emilia-Romagna ST-segment elevation acute myocardial infarction network Eur. Heart J., July 10, 2008; (2008) ehn323v1. [Abstract] [Full Text] [PDF]

				S. R. Dixon, C. L. Grines, and W. W. O'Neill The year in interventional cardiology. J. Am. Coll. Cardiol., June 17, 2008; 51(24): 2355 - 2369. [Full Text] [PDF]

				F. V. Aguirre, J. J. Varghese, M. P. Kelley, W. Lam, C. L. Lucore, J. B. Gill, L. Page, L. Turner, C. Davis, and F. L. Mikell Rural Interhospital Transfer of ST-Elevation Myocardial Infarction Patients for Percutaneous Coronary Revascularization: The Stat Heart Program Circulation, March 4, 2008; 117(9): 1145 - 1152. [Abstract] [Full Text] [PDF]

				D. R. Holmes Jr, M. R. Bell, B. J. Gersh, C. S. Rihal, L. H. Haro, C. M. Bjerke, R. J. Lennon, C.-C. Lim, and H. H. Ting Systems of Care to Improve Timeliness of Reperfusion Therapy for ST-Segment Elevation Myocardial Infarction During Off Hours: The Mayo Clinic STEMI Protocol J. Am. Coll. Cardiol. Intv., February 1, 2008; 1(1): 88 - 96. [Abstract] [Full Text] [PDF]

				C. Kasapis and B. K. Nallamothu Use of the electrocardiogram in optimizing reperfusion for ST-elevation myocardial infarction: a new role for an old tool? Eur. Heart J., December 2, 2007; 28(24): 2957 - 2959. [Full Text] [PDF]

				J. G. Jollis, M. L. Roettig, A. O. Aluko, K. J. Anstrom, R. J. Applegate, J. D. Babb, P. B. Berger, D. J. Bohle, S. M. Fletcher, J. L. Garvey, et al. Implementation of a Statewide System for Coronary Reperfusion for ST-Segment Elevation Myocardial Infarction JAMA, November 28, 2007; 298(20): 2371 - 2380. [Abstract] [Full Text] [PDF]

				B. K. Nallamothu, E. H. Bradley, and H. M. Krumholz Time to Treatment in Primary Percutaneous Coronary Intervention N. Engl. J. Med., October 18, 2007; 357(16): 1631 - 1638. [Full Text] [PDF]

				Regionally Coordinated Systems of Care for Patients with STEMI Journal Watch Emergency Medicine, September 28, 2007; 2007(928): 3 - 3. [Full Text]

				Regionalizing Care for Acute MI Patients Journal Watch Cardiology, September 12, 2007; 2007(912): 3 - 3. [Full Text]