Abstract 14267: Comprehensive STEMI Protocol Enhances Process and Care Metrics in Patients With In-Hospital STEMI

Abstract

Introduction: Patients who experience in-hospital ST-elevation myocardial infarction (iSTEMI) represent a uniquely high-risk cohort owing to delays in diagnosis and time to reperfusion as well as substantially increased mortality. Quality initiatives aimed at improving the care of this vulnerable, yet understudied population are needed. Methods: This study included consecutive patients with iSTEMI treated with percutaneous coronary intervention (PCI) between 01/01/2011-07/15/2019 at a single, tertiary referral center. A comprehensive iSTEMI protocol (CSP) was implemented on 7/15/2014, incorporating: (1) nursing chest pain protocol, (2) improved electronic access to ECG images, (3) checklist for initial triage and management, (4) 24/7/365 catheterization lab readiness, and (5) radial-first PCI approach. Key metrics and outcomes were compared before and after CSP implementation. Results: Among 132 total subjects, the post-CSP cohort (n=84) were older with more males and active smoking relative to the pre-CSP cohort (n=48). After CSP adoption, we observed significant reductions in median door-to balloon time (D2BT) from 107 minutes to 64 minutes (p<0.001), median fluoroscopy dose from 1.6 Gy to 1.2 Gy (p=0.04), and mean contrast load from 181mL to 148mL (p=0.02), with simultaneous increases in goal D2BT from 39% to 74% of patients (p<0.001) as well as radial use from 15% to 70% (p<0.001). Despite a numerical decrease in in-hospital mortality after CSP application from 17% to 10% (p=0.35), no significant differences were found in all outcomes including 30-day and 1-year mortality between groups. Conclusion: The implementation of a CSP was associated with marked improvements in critical process and care metrics among vulnerable patients who experience STEMI while hospitalized. Interestingly, these benefits failed to improve short or long-term outcomes including mortality, highlighting the underlying high-risk nature of this population.