STEMI Accelerator: Faster emergency response linked to improved survival

CHICAGO — A coordinated response between emergency medical personnel and hospital staff was associated with faster care and improved survival in patients with STEMI, researchers reported at the American Heart Association Scientific Sessions.

“There is strong evidence that timely reperfusion improves outcomes in patients with STEMI,” Matthew W. Sherwood, MD, from Duke Clinical Research Institute, said. “Yet, only half of patients are treated within currently recommended guideline goals.”

Matthew W. Sherwood

Sherwood and colleagues conducted a study of the use and timeliness of reperfusion therapy for STEMI in a large cohort of US patients. The Regional Systems of Care Demonstration Project, Mission: Lifeline STEMI Accelerator, included 16 metropolitan areas comprising 10% of the US population. Researchers tracked more than 24,000 MI patients across 484 hospitals and 1,258 emergency medical services agencies during the implementation phase of the project from July 1, 2012, to March 31, 2014.

During the study period, the proportion of patients arriving by emergency medical services who were treated within 90 minutes of first medical contact increased from 54% to 59% (P=.0046).

“We found that nearly all of the regions would have met previously established guideline goals for door-to-device time, but very few of the regions would have met current goals for first medical contact-to-device time,” Sherwood said. “This is a key area of improvement in STEMI care.”

Although the aggregate improvement in first medical contact-to-device time was moderate for the overall cohort, the improvement seen in the top five performing regions was between 10% and 20%, according to Sherwood.

“We believe that this indicates that there is a lot of potential for improvement for the regions that are able to implement all of the steps in our study,” he said.

A shorter duration in the ED was associated with improved survival outcomes, according to results of a multivariate analysis. Patients in the ED for 30 minutes or less had a mortality rate of 3.6% vs. 7% for those in the ED for 30 to 45 minutes and 10.8% for those in the ED for longer than 45 minutes (P<.001).

“Lower ED time is associated with improved survival,” he said. “Regional systems of STEMI care can provide important improvements to public health.”

Sherwood said individual health systems have demonstrated improved reperfusion times and associated improved outcomes, but that the investigators in the current study focused on regional systems of care.

For more information:

Sherwood MW. Abstract #20751. Presented at: American Heart Association Scientific Sessions; Nov. 15-19, 2014; Chicago.

Disclosure: The researchers report associations with AstraZeneca, Abiomed Philips Healthcare and The Medicines Company.