Implementation of an acute myocardial infarction team over 13 years achieved an average electrocardiogram-to-wire crossing time of 92.9 minutes, with 72.9% of cases completed within 90 minutes.
Observational (n=825)
No
Does the implementation and optimization of an AMI team improve timely reperfusion performance in patients with STE-ACS?
The implementation of a dedicated AMI team, supported by international accreditation, significantly improved timely reperfusion metrics for STE-ACS patients over a 13-year period.
Objectives: Acute myocardial infarction (AMI)—particularly ST-segment elevation acute coronary syndrome (STE-ACS)—remains one of the leading causes of mortality worldwide. Evidence consistently demonstrates that early recognition, timely diagnosis, and prompt reperfusion are critical to reduce mortality. There is an urgent need to establish coordinated AMI team to optimize treatment processes and outcomes. This study aimed to evaluate the implementation and performance of an AMI team in a public hospital in Macao over a 13-year period, assessing trends in reperfusion strategy, treatment timeliness, and quality-of-care indicators. Methods: We conducted a retrospective observational study evaluating the implementation of an AMI team in a public hospital in Macao. All consecutive patients with STE-ACS from January 2013 to December 2025 were included that the diagnosis was confirmed by coronary angiography. Primary percutaneous coronary intervention (PCI) was the preferred reperfusion strategy; fibrinolysis followed by rescue or facilitated PCI was used when timely primary PCI was not feasible. Patients without coronary angiography or with non-coronary etiologies (e.g., Takotsubo cardiomyopathy or peri-myocarditis) were excluded. The primary outcome was timely reperfusion performance, defined as electrocardiogram-to-wire crossing time and the proportion achieving reperfusion within 90 minutes. Secondary outcomes included annual primary PCI rate. Results: From 2013 to 2025, totally 5188 cases of coronary artery intervention (including coronary angiography and treatment) were performed in 13 years (average 399.1 per year). Among those, 60.0% (3110/5188) was elective, 24.1% (1253/5188) was non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and 15.9% (825/5188) was STE-ACS. AMI cases are increasing in the past 13 years. For those 825 cases of STE-ACS, we achieved an average of 81.9% primary PCI, while 58.3% in 2013 (the first-year establishment of AMI team), and almost 90% between 2017 and 2019 after support by The Australian Council on Healthcare Standards (ACHS) Accreditation in 2016. The average electrocardiography STE-ACS diagnosis to wire crossing time, which represents the time from diagnosis to blood flow recover, was 92.9 minutes in the past 13 years. However, it was down-trending from peak of 124 minutes in 2015, to 62 minutes in 2024, and rebounded to 91.7 minutes in 2025 after extracorporeal membrane oxygenation service was started. Over this period, average 72.9% of the cases were completed within 90 minutes. It was up-trending from trough of 50.0% in 2013, to crest of 89.2% in 2023. Those important parameters indicated a significant improvement of AMI team. Conclusion: This real-world, single-centre retrospective study demonstrated that the performance of AMI team can be improved through medical executive enhancement by international accreditation support.
Lao et al. (Wed,) conducted a observational in ST-segment elevation acute coronary syndrome (STE-ACS) (n=825). Acute myocardial infarction (AMI) team implementation was evaluated on Timely reperfusion performance (electrocardiogram-to-wire crossing time and proportion achieving reperfusion within 90 minutes). Implementation of an acute myocardial infarction team over 13 years achieved an average electrocardiogram-to-wire crossing time of 92.9 minutes, with 72.9% of cases completed within 90 minutes.