An analysis of a study called Mission: Lifeline STEMI Accelerator II found that when patients experiencing an ST-elevation myocardial infarction present in facilities not capable of performing percutaneous intervention, the time between their arrival and cath lab activation is an important quality metric to direct timely reperfusion.
A faster catheterization laboratory (cath lab) activation by the first receiving facility is associated with faster treatment for patients with ST-elevation myocardial infarction (STEMI) according to a new study conducted by the DCRI in collaboration with the American Heart Association. Analysis of the Mission: Lifeline STEMI Accelerator II study was led by DCRI fellow Michel Zeitouni, MD, and results were recently published in Circulation: Cardiovascular Quality and Outcomes.
Cath lab activation time is a relatively new process measure in caring for patients who are admitted with STEMI to facilities that are unable to perform primary percutaneous intervention (PCI). Guidelines recommend that patients who experience STEMI receive PCI within two hours after the STEMI occurs. The study team sought to find out whether faster cath lab activation times would help more procedures be administered within this critical window.
The study, called Mission: Lifeline STEMI Accelerator-2, examined the treatment times of 2,063 patients who presented with STEMI in a facility that was not capable of performing primary percutaneous intervention and had to be transferred between hospitals to receive treatment. The study team split patients into two groups based on their cath lab activation times—a “timely” group that was activated within 20 minutes, and a “delayed” group that had to wait longer than 20 minutes.
Delayed activation was observed in more than half (60.2 percent) of patients, with a median cath lab activation time of 26 minutes. Only 39 percent of patients who had a delayed activation time received primary percutaneous intervention within the recommended timeframe of two hours. However, of those patients who were activated in a timely manner, 80.1 percent received primary percutaneous intervention within the guideline of two hours post-STEMI. Of importance, the transfer time only accounted for an average of 20 percent of the overall time to reperfusion. Several patient characteristics were linked to delayed activation times, including prior cardiovascular or cerebrovascular disease, shock at admission, and ethnicity—with black and Latino patients more likely to have longer wait times.
“These results suggest that the novel cath lab activation time measure will be increasingly important to consider when treating patients who require inter-hospital transfer,” Zeitouni said. “By actively directing resources to a more timely activation in the receiving facilities, we can help patients receive treatment within a critical window, thereby improving patient outcomes.”
“These findings are particularly important during the COVID-19 pandemic, when we’re seeing fear of the virus discourage patients from seeking the life-saving care they need when they experience other emergencies,” said James Jollis, MD, senior investigator for Mission: Lifeline STEMI Accelerator-2. “Time is of the essence in treating these conditions, so we really need to encourage people experiencing a heart attack to seek help as soon as they experience symptoms.”
This analysis was also featured in Cardiology Today. Other DCRI contributors include Hussein Al-Khalidi, PhD; Anne Hellkamp, MS; Lisa Monk, RN, MSN; and Christopher Granger, MD.