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Hospital Improvement in Time to Reperfusion in Patients With Acute Myocardial Infarction, 1999 to 2002

Robert L. McNamara, MD, MHS, FACC^_*, Jeph Herrin, PhD^_*,, Elizabeth H. Bradley, PhD, Edward L. Portnay, MD^_*, Jeptha P. Curtis, MD^_*, Yongfei Wang, MS^_*, David J. Magid, MD, MPH^||,¶, Martha Blaney, PharmD^#, Harlan M. Krumholz, MD, SM, FACC^_*,,,_**,_* for the NRMI Investigators

^_* Department of Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut
Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut
Flying Buttress Associates, Charlottesville, Virginia
^|| Clinical Research Unit, Kaiser Permanente, Denver, Colorado
^¶ Departments of Emergency Medicine and Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, Colorado
^# Genentech Inc., South San Francisco, California
^_** Center for Outcomes Research and Evaluation, Yale-New Haven Health System, New Haven, Connecticut

View larger version (27K): [in a new window]   Figure 1 Guideline adherence. Proportions of patients receiving either fibrinolytic therapy (A) or percutaneous coronary intervention (B) within the ACC/AHA recommended times (17) are indicated in black. The proportions of additional patients receiving late reperfusion, defined as the recommended time plus one-third (40 min for fibrinolytic therapy and 120 min for percutaneous coronary intervention) are indicated in white. The proportions of patients receiving reperfusion between these times are indicated in the diagonal pattern.

View larger version (14K): [in a new window]   Figure 2 Calendar time trend. The geometric mean door-to-needle times for 68,439 patients (white squares) and geometric mean door-to-balloon times for 33,647 patients (black diamonds) for each quarter from January 1999 to December 2002. There was no significant trend for either door-to-needle times (p = 0.956) or door-to-balloon times (p = 0.094).

View larger version (32K): [in a new window]   Figure 3 Distribution of Improvement. Improvement over the study period for each of the 1,015 hospitals reporting for fibrinolytic therapy (A) and for each of the 421 hospitals reporting for percutaneous coronary intervention (B). For illustration purposes, those hospitals that improved by an average of 1 min for fibrinolytic therapy and 3 min for percutaneous coronary intervention are indicated in white; those hospitals that worsened by an average of 1 min for fibrinolytic therapy and 3 min for PCI are indicated in black; and those hospitals in between these times are indicated in the diagonal pattern.