Catheterization Laboratory Activation Time in Patients Transferred with ST-Segment-Elevation Myocardial Infarction: Insights from the Mission: Lifeline STEMI Accelerator-2 Project

Michel Zeitouni, Hussein R. Al-Khalidi, Mayme L. Roettig, Michele M. Bolles, Shannon M. Doerfler, Christopher B. Fordyce, Anne S. Hellkamp, Timothy D. Henry, Zainab Magdon-Ismail, Lisa Monk, R. Darrell Nelson, Peter K. O'Brien, B. Hadley Wilson, Khaled M. Ziada, Christopher B. Granger, James G. Jollis

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: Catheterization laboratory (cath lab) activation time is a newly available process measure for patients with ST-segment-elevation myocardial infarction requiring inter-hospital transfers for primary percutaneous coronary intervention that reflects inter-facility communication and urgent mobilization of interventional laboratory resources. Our aim was to determine whether faster activation is associated with improved reperfusion time and outcomes in the American Heart Association Mission: Lifeline Accelerator-2 Project. Methods and Results: From April 2015 to March 2017, treatment times of 2063 patients with ST-segment-elevation myocardial infarction requiring inter-hospital transfer for primary percutaneous coronary intervention from 12 regions around the United States were stratified by cath lab activation time (first hospital arrival to cath lab activation within [timely] or beyond 20 minutes [delayed]). Median cath lab activation time was 26 minutes, with a delayed activation observed in 1241 (60.2%) patients. Prior cardiovascular or cerebrovascular disease, arterial hypotension at admission, and black or Latino ethnicity were independent factors of delayed cath lab activation. Timely cath lab activation patients had shorter door-in door-out times (40 versus 68 minutes) and reperfusion times (98 versus 135 minutes) with 80.1% treated within the national goal of ≤120 minutes versus 39.0% in the delayed group. Conclusions: Cath lab activation within 20 minutes across a geographically diverse group of hospitals was associated with performing primary percutaneous coronary intervention within the national goal of ≤120 minutes in >75% of patients. While several confounding factors were associated with delayed activation, this work suggests that this process measure has the potential to direct resources and practices to more timely treatment of patients requiring inter-hospital transfer for primary percutaneous coronary intervention.

Original languageEnglish
Pages (from-to)404-414
Number of pages11
JournalCirculation: Cardiovascular Quality and Outcomes
Volume13
Issue number7
DOIs
StatePublished - Jul 1 2020

Bibliographical note

Funding Information:
The Regional Systems Accelerator-2 study was supported by the American College of Cardiology Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry and the American Heart Association’s Mission: Lifeline hospital joint registry ACTION Registry Get With The Guidelines (ACTION Registry-GWTG). The ACCELERATOR-2 study was funded by education and research grants by AstraZeneca and the Medicines Company.

Funding Information:
Dr Zeitouni has received research grants from Federation Française de Cardi-ologie, Institut Servier, and lecture fees from Bristol Myers Squibb/Pfizer. M.M. Bolles is a paid employee of the American Heart Association. Dr Fordyce has received honorarium/consulting fees from Bayer, Sanofi, Pfizer, Novo Nordisk and Boringher Ingelheim and research grants from Bayer. Z. Magdon-Ismail is a paid employee of the American Heart Association. Dr Granger has received Research grants from Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Dai-ichi Sankyo, Janssen, Pfizer, Armetheon, AstraZeneca, US Food & Drug Administration, GlaxoSmithKline, The Medicines Company, Medtronic Foundation, Medtronic Inc, and Novartis; consulting fees from Bayer, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, Daiichi Sankyo, Janssen, Pfizer, Ab-bvie, Armetheon, Astra Zeneca, Eli Lilly, Gilead, GlaxoSmithKline, Hoffmann-La Roche, The Medicines Company, National Institutes of Health, Novartis, Sirtex, Verseon, Apple, Medscape, LLC, Merck, Novo Nordisk, Roche Diagnostics, and Rho Pharmaceuticals. The other authors report no conflicts.

Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.

Keywords

  • catheterization
  • coronary artery disease
  • hypotension
  • myocardial infarction
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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