Background Patients who experience in-hospital ST-segment elevation myocardial infarction (iSTEMI) represent a uniquely high-risk cohort owing to delays in diagnosis, prolonged time to reperfusion and increased mortality. Quality initiatives aimed at improving the care of this vulnerable, yet understudied population are needed. Methods This study included consecutive patients with iSTEMI treated with percutaneous coronary intervention (PCI) between 1 January 2011 and 15 July 2019 at a single, tertiary referral centre. A comprehensive iSTEMI protocol (CSP) was implemented on 15 July 2014, incorporating: (1) cardiology fellow activation of the catheterisation lab using standardised criteria, (2) nursing chest pain protocol, (3) improved electronic access to electrocardiographic studies, (4) checklist for initial triage and management, (5) 24/7/365 catheterisation lab readiness and (6) radial-first PCI approach. Key metrics and clinical outcomes were compared before and after CSP implementation. Results Among 125 total subjects, the post-CSP cohort (n=81) was younger, had more males and were more likely to be hospitalised for cardiac-related reasons relative to the pre-CSP cohort (n=44) who were more likely hospitalised for operative-related aetiologies. After CSP adoption, median ECG-to-first-device-activation time decreased from 113 min to 64 min (p<0.001), goal ECG-to-first-device-activation time increased from 36% to 76% of patients (p<0.001), administration of guideline-directed medical therapy prior to PCI increased from 27.3% to 65.4% (p<0.001), trans-radial access increased from 16% to 70% (p<0.001) and rates of discharge home increased from 56.8% to 76.5% (p=0.04). Statistically insignificant numerical reductions were observed post-CSP in in-hospital mortality (18.2% vs 9.9%, p=0.30), 30-day mortality (15.9% vs 12.3%, p=0.78) and 1-year mortality (27.3% vs 21.0%, p=0.57). Conclusions The implementation of a CSP was associated with marked enhancements in key care metrics among patients with iSTEMI. Among a larger cohort, the use of a CSP yielded a significant reduction in ECG-to-first-device-activation time in a particularly vulnerable population at high risk of death. No data are available.

中文翻译：

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实施全面的 STEMI 方案以改善住院 STEMI 患者的护理指标和结果：一项观察性队列研究

背景 院内发生 ST 段抬高型心肌梗死 (iSTEMI) 的患者由于诊断延迟、再灌注时间延长和死亡率增加而成为独特的高危人群。需要采取旨在改善对这一弱势群体但尚未得到充分研究的人群的护理的高质量举措。方法 本研究纳入了 2011 年 1 月 1 日至 2019 年 7 月 15 日期间在单一三级转诊中心接受经皮冠状动脉介入治疗 (PCI) 的连续 iSTEMI 患者。2014 年 7 月 15 日实施了全面的 iSTEMI 协议 (CSP)，其中包括：(1) 使用标准化标准激活导管实验室的心脏病学研究员，(2) 护理胸痛协议，(3) 改进心电图研究的电子访问，(4 ) 初始分类和管理清单，(5) 24/7/365 导管插入实验室准备情况和 (6) 桡动脉优先 PCI 方法。比较 CSP 实施前后的关键指标和临床结果。结果 在总共 125 名受试者中，CSP 后队列 (n=81) 相对于 CSP 前队列 (n=44) 更年轻，男性更多，并且更有可能因心脏相关原因住院。因手术相关病因住院。采用 CSP 后，心电图到第一个设备激活时间中位数从 113 分钟减少到 64 分钟 (p<0.001)，目标心电图到第一个设备激活时间从 36% 增加到 76% (p<0.001)。 <0.001），PCI 前接受指南指导的药物治疗从 27.3% 增加到 65.4%（p<0.001），经桡动脉入路从 16% 增加到 70%（p<0.001），出院率从56.8% 至 76.5% (p=0.04)。CSP 后院内死亡率（18.2% vs 9.9%，p=0.30）、30 天死亡率（15.9% vs 12.3%，p=0.78）和 1 年死亡率（27.3% vs 21.0%，p=0.57）。结论 CSP 的实施与 iSTEMI 患者关键护理指标的显着增强相关。在更大的队列中，对于死亡风险特别高的弱势群体，使用 CSP 显着缩短了心电图到首次设备激活的时间。无可用数据。