Background:
Regional ST-elevation myocardial infarction (STEMI) networks have been established to improve timely access to primary percutaneous coronary intervention (PCI) in the United States, but the assessment of hospital-level performance in this setting is challenging due to the stratification of reperfusion timing metrics by initial mode of patient presentation.
Methods:
We developed a new hospital-level time-to-treatment metric for primary PCI at 588 PCI-capable hospitals (>40 patients/yr) participating in the AHA Mission: Lifeline® program from 2007[[Unable to Display Character: –]]2013. Patients were categorized as Group 1: Self or ambulance transport with no pre-hospital electrocardiogram (ECG), Group 2: Ambulance transport with ST-elevation on a pre-hospital ECG, and Group 3: Inter-hospital transfer with ST-elevation on an ECG at the referring hospital. Timing metrics for these populations were 1: Door-to-device time, 2: First medical contact-to-device time, 3: First door-to-device time, respectively. Patient times were converted to minutes ahead or behind of their group-specific mean, and overall hospital performance was measured by taking the mean time for all STEMI patients at a given site (using the new “centered time-to-device” metric with negative values behind the mean representing longer time intervals).
Results:
A total of 120,208 STEMI patients were evaluated across 588 hospitals with a median number of 85 (25
th
, 75
th
percentiles: 61, 128) patients/hospital/year. The median hospital-level proportion of patients in Groups 1, 2, and 3 were 46%, 33%, and 20%, respectively. Significant differences in time-to-treatment and “centered time-to-device” were seen from lowest to highest hospital tertiles (Table).
Conclusions:
A new, comprehensive hospital-level assessment of time-to-treatment for primary PCI that accounts for all STEMI patients treated at a given hospital, regardless of mode of presentation, reliably distinguished top-performing hospitals.
THE IMPACT OF BLEEDING AVOIDANCE STRATEGIES ON HOSPITAL-LEVEL VARIATION IN BLEEDING RATES FOLLOWING PERCUTANEOUS CORONARY INTERVENTION: INSIGHTS FROM THE NCDR CATHPCI REGISTRY
