Implementation of a statewide system for coronary reperfusion for ST-segment elevation myocardial infarction
| Autor: | James G. Jollis, William T. Maddox, Robert J. Applegate, Joseph Shiber, William R. Hathaway, Bradley A. Watling, Peter B. Berger, Sidney M. Fletcher, Mayme L. Roettig, Kevin J. Anstrom, David J. Bohle, Joseph D. Babb, James W. Hoekstra, F. Scott Valeri, Robert V. Kelly, B. Hadley Wilson, J. Lee Garvey, Christopher B. Granger, Akinyele O. Aluko |
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| Rok vydání: | 2007 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Myocardial Infarction Myocardial Reperfusion Killip Class III Reperfusion therapy Internal medicine medicine North Carolina Humans cardiovascular diseases Myocardial infarction Aged Quality of Health Care business.industry Cardiogenic shock ST elevation Percutaneous coronary intervention General Medicine Emergency department Middle Aged medicine.disease surgical procedures operative Outcome and Process Assessment Health Care Conventional PCI Emergency medicine Cardiology business Emergency Service Hospital |
| Zdroj: | JAMA. 298(20) |
| ISSN: | 1538-3598 |
| Popis: | ContextDespite 2 decades of evidence demonstrating benefits from prompt coronary reperfusion, registries continue to show that many patients with ST-segment elevation myocardial infarction (STEMI) are treated too slowly or not at all.ObjectiveTo establish a statewide system for reperfusion, as exists for trauma care, to overcome systematic barriers.Design and SettingA quality improvement study that examined the change in speed and rate of coronary reperfusion after system implementation in 5 regions in North Carolina involving 65 hospitals and associated emergency medical systems (10 percutaneous coronary intervention [PCI] hospitals and 55 non-PCI hospitals).PatientsA total of 1164 patients with STEMI (579 preintervention and 585 postintervention) eligible for reperfusion were treated at PCI hospitals (median age 61 years, 31% women, 4% Killip class III or IV). A total of 925 patients with STEMI (518 preintervention and 407 postintervention) were treated at non-PCI hospitals (median age 62 years, 32% women, 4% Killip class III or IV).InterventionsEarly diagnosis and the most expedient coronary reperfusion method at each point of care: emergency medical systems, emergency department, catheterization laboratory, and transfer. Within 5 regions, PCI hospitals agreed to provide single-call catheterization laboratory activation by emergency medical personnel, accept patients regardless of bed availability, and improve STEMI care for the entire region regardless of hospital affiliation.Main Outcome MeasuresReperfusion times and rates 3 months before (July to September 2005) and 3 months after (January to March 2007) a year-long implementation.ResultsMedian reperfusion times significantly improved according to first door-to-device (presenting to PCI hospital 85 to 74 minutes, P |
| Databáze: | OpenAIRE |
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