Treatment Time and In-Hospital Mortality Among Patients With ST-Segment Elevation Myocardial Infarction, 2018-2021

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 lt;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.