Process Factors Affecting Reperfusion Time in Patients With ST-Segment Elevation Myocardial Infarction.

OBJECTIVE: To determine process factors impacting myocardial infarction reperfusion time. BACKGROUND: An ST-segment elevation myocardial infarction (STEMI) is a life-threatening condition that necessitates emergent medical treatment; longer reperfusion times are associated with negative patient outcomes. Therefore, time is critical in the treatment of a STEMI. METHODS: Admissions data from Las Vegas hospitals were analyzed via multivariate regression analysis to determine predictors of reperfusion times. The analysis was based on 618 patients presenting with a diagnosis of STEMI at participating facilities from 1 January 2015 to 31 December 2017. The dependent variable was door to balloon time; independent variables included the mode of arrival, regular vs off hours, pre-hospital electrocardiogram (ECG), the use of pre-hospital activation of the STEMI protocol, door to triage time, door to ECG time, door to first physician contact time, cardiologist arrival time, cardiac catheterization lab team arrival time, lifesaving measures prior to percutaneous coronary intervention (PCI), critical diagnostic exams prior to PCI, and anatomical variances causing PCI delay. RESULTS: Prehospital STEMI activation, cardiologist arrival time, lifesaving measures, door to ECG time, time/day, critical diagnostics exams, and door to first MD time all had a statistically significant impact on door-to-balloon time (p < 0.05). CONCLUSIONS: Timely identification of STEMI patients via ECG and activation of the STEMI protocol is paramount to shorten time to heart vessel reperfusion. However, this study indicates that some process factors indicated previously to impact reperfusion times did not have significantly effects in this study sample.