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Catheterization Laboratory Activation Time in Patients Transferred With ST-Segment-Elevation Myocardial Infarction: Insights From the Mission: Lifeline STEMI Accelerator-2 Project.

Publication ,  Journal Article
Zeitouni, M; Al-Khalidi, HR; Roettig, ML; Bolles, MM; Doerfler, SM; Fordyce, CB; Hellkamp, AS; Henry, TD; Magdon-Ismail, Z; Monk, L; Nelson, RD ...
Published in: Circ Cardiovasc Qual Outcomes
July 2020

BACKGROUND: Catheterization laboratory (cath lab) activation time is a newly available process measure for patients with ST-segment-elevation myocardial infarction requiring inter-hospital transfers for primary percutaneous coronary intervention that reflects inter-facility communication and urgent mobilization of interventional laboratory resources. Our aim was to determine whether faster activation is associated with improved reperfusion time and outcomes in the American Heart Association Mission: Lifeline Accelerator-2 Project. METHODS AND RESULTS: From April 2015 to March 2017, treatment times of 2063 patients with ST-segment-elevation myocardial infarction requiring inter-hospital transfer for primary percutaneous coronary intervention from 12 regions around the United States were stratified by cath lab activation time (first hospital arrival to cath lab activation within [timely] or beyond 20 minutes [delayed]). Median cath lab activation time was 26 minutes, with a delayed activation observed in 1241 (60.2%) patients. Prior cardiovascular or cerebrovascular disease, arterial hypotension at admission, and black or Latino ethnicity were independent factors of delayed cath lab activation. Timely cath lab activation patients had shorter door-in door-out times (40 versus 68 minutes) and reperfusion times (98 versus 135 minutes) with 80.1% treated within the national goal of ≤120 minutes versus 39.0% in the delayed group. CONCLUSIONS: Cath lab activation within 20 minutes across a geographically diverse group of hospitals was associated with performing primary percutaneous coronary intervention within the national goal of ≤120 minutes in >75% of patients. While several confounding factors were associated with delayed activation, this work suggests that this process measure has the potential to direct resources and practices to more timely treatment of patients requiring inter-hospital transfer for primary percutaneous coronary intervention.

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Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

July 2020

Volume

13

Issue

7

Start / End Page

e006204

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time-to-Treatment
  • Time Factors
  • ST Elevation Myocardial Infarction
  • Quality Indicators, Health Care
  • Quality Improvement
  • Percutaneous Coronary Intervention
  • Patient Transfer
  • Outcome and Process Assessment, Health Care
 

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Zeitouni, M., Al-Khalidi, H. R., Roettig, M. L., Bolles, M. M., Doerfler, S. M., Fordyce, C. B., … Jollis, J. G. (2020). Catheterization Laboratory Activation Time in Patients Transferred With ST-Segment-Elevation Myocardial Infarction: Insights From the Mission: Lifeline STEMI Accelerator-2 Project. Circ Cardiovasc Qual Outcomes, 13(7), e006204. https://doi.org/10.1161/CIRCOUTCOMES.119.006204
Zeitouni, Michel, Hussein R. Al-Khalidi, Mayme L. Roettig, Michele M. Bolles, Shannon M. Doerfler, Christopher B. Fordyce, Anne S. Hellkamp, et al. “Catheterization Laboratory Activation Time in Patients Transferred With ST-Segment-Elevation Myocardial Infarction: Insights From the Mission: Lifeline STEMI Accelerator-2 Project.Circ Cardiovasc Qual Outcomes 13, no. 7 (July 2020): e006204. https://doi.org/10.1161/CIRCOUTCOMES.119.006204.
Zeitouni M, Al-Khalidi HR, Roettig ML, Bolles MM, Doerfler SM, Fordyce CB, et al. Catheterization Laboratory Activation Time in Patients Transferred With ST-Segment-Elevation Myocardial Infarction: Insights From the Mission: Lifeline STEMI Accelerator-2 Project. Circ Cardiovasc Qual Outcomes. 2020 Jul;13(7):e006204.
Zeitouni, Michel, et al. “Catheterization Laboratory Activation Time in Patients Transferred With ST-Segment-Elevation Myocardial Infarction: Insights From the Mission: Lifeline STEMI Accelerator-2 Project.Circ Cardiovasc Qual Outcomes, vol. 13, no. 7, July 2020, p. e006204. Pubmed, doi:10.1161/CIRCOUTCOMES.119.006204.
Zeitouni M, Al-Khalidi HR, Roettig ML, Bolles MM, Doerfler SM, Fordyce CB, Hellkamp AS, Henry TD, Magdon-Ismail Z, Monk L, Nelson RD, O’Brien PK, Wilson BH, Ziada KM, Granger CB, Jollis JG. Catheterization Laboratory Activation Time in Patients Transferred With ST-Segment-Elevation Myocardial Infarction: Insights From the Mission: Lifeline STEMI Accelerator-2 Project. Circ Cardiovasc Qual Outcomes. 2020 Jul;13(7):e006204.

Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

July 2020

Volume

13

Issue

7

Start / End Page

e006204

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time-to-Treatment
  • Time Factors
  • ST Elevation Myocardial Infarction
  • Quality Indicators, Health Care
  • Quality Improvement
  • Percutaneous Coronary Intervention
  • Patient Transfer
  • Outcome and Process Assessment, Health Care