Abstract 12192: Improving Care of ST Segment Elevation Myocardial Infarction in the United States 2008 to 2012: A Report From Mission: Lifeline
Care guidelines recommend regional systems to optimize reperfusion for patients with ST segment elevation myocardial infarction (STEMI). But such treatment is often delayed or not given at all. Mission: Lifeline is an ongoing American Heart Association STEMI systems of care program.
Methods: Mission: Lifeline has defined and promoted ideal elements for regional STEMI care at the EMS, hospital, and system levels. Hospitals measure processes and outcomes using ACTION Registry/Get with the Guidelines. In-hospital adjusted mortality was calculated including and excluding cardiac arrest as a reason for PCI delay and pre-hospital cardiac arrest (collected since 2011).
Results: A total of 147,466 patients with STEMI from 485 hospitals registered with Mission: Lifeline are included. Median age was 61 years and symptom onset to first medical contact was 50 minutes and stable over 5 years. Use of primary PCI and of pre-hospital ECGs, and times from first medical contact (direct presenters) and from first door (transfers) to primary PCI significantly improved (p≤0.0001) (Table). The percent of eligible patients not reperfused decreased in half. Guidelines now recommend primary PCI in patients with cardiac arrest and STEMI, a group with high mortality. While complete information on pre-hospital cardiac arrest has only been collected since 2011, mortality, adjusted for baseline predictors and removing patients with known cardiac arrest, has decreased over time (p≤0.0001).
Conclusions: A comprehensive national systems of care program has significantly improved quality of care for STEMI including increased use of reperfusion therapy and faster primary PCI. While assessing overall impact on STEMI mortality with changing practice around cardiac arrest is challenging, this highlights the need for improving system-level care for out-of-hospital cardiac arrest, an ongoing objective of Mission: Lifeline.
- Myocardial infarction, STEMI
- Systems of care
- Percutaneous coronary intervention
- Healthcare delivery systems
- © 2013 by American Heart Association, Inc.