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עברית
Key Points
Question What were the treatment times and in-hospital mortality among US patients with ST-segment elevation myocardial infarction (STEMI) between 2018 and 2021?
Findings In this serial cross-sectional registry study that included 114 871 patients with STEMI, the median time to treatment was 86 minutes in the second quarter of 2018 and 91 minutes in the first quarter of 2021, a statistically significant difference. In-hospital mortality increased from 5.6% in the second quarter of 2018 to a peak of 8.7% in the first quarter of 2021, both statistically significant increases.
Meaning This study provides registry data that inform understanding of the contemporary pattern of care and outcomes in US patients with STEMI. 
Abstract
Importance Recognizing the association between timely treatment and less myocardial injury for patients with ST-segment elevation myocardial infarction (STEMI), US national guidelines recommend specific treatment-time goals.
Objective To describe these process measures and outcomes for a recent cohort of patients.
Design, Setting, and Participants Cross-sectional study of a diagnosis-based registry between the second quarter of 2018 and the third quarter of 2021 for 114 871 patients with STEMI treated at 648 hospitals in the Get With The Guidelines–Coronary Artery Disease registry.
Exposures STEMI or STEMI equivalent.
Main Outcomes and Measures Treatment times, in-hospital mortality, and adherence to system goals (75% treated ≤90 minutes of first medical contact if the first hospital is percutaneous coronary intervention [PCI]-capable and ≤120 minutes if patients require transfer to a PCI-capable hospital).
Results In the study population, median age was 63 (IQR, 54-72) years, 71% were men, and 29% were women. Median time from symptom onset to PCI was 148 minutes (IQR, 111-226) for patients presenting to PCI-capable hospitals by emergency medical service, 195 minutes (IQR, 127-349) for patients walking in, and 240 minutes (IQR, 166-402) for patients transferred from another hospital. Adjusted in-hospital mortality was lower for those treated within target times vs beyond time goals for patients transported via emergency medical services (first medical contact to laboratory activation ≤20 minutes [in-hospital mortality, 3.6 vs 9.2] adjusted OR, 0.54 [95% CI, 0.48-0.60], and first medical contact to device ≤90 minutes [in-hospital mortality, 3.3 vs 12.1] adjusted OR, 0.40 [95% CI, 0.36-0.44]), walk-in patients (hospital arrival to device ≤90 minutes [in-hospital mortality, 1.8 vs 4.7] adjusted OR, 0.47 [95% CI, 0.40-0.55]), and transferred patients (door-in to door-out time <30 minutes [in-hospital mortality, 2.9 vs 6.4] adjusted OR, 0.51 [95% CI, 0.32-0.78], and first hospital arrival to device ≤120 minutes [in-hospital mortality, 4.3 vs 14.2] adjusted OR, 0.44 [95% CI, 0.26-0.71]). Regardless of mode of presentation, system goals were not met in most quarters, with the most delayed system performance among patients requiring interhospital transfer (17% treated ≤120 minutes).
Conclusions and Relevance This study of patients with STEMI included in a US national registry provides information on changes in process and outcomes between 2018 and 2021.
