Coronary disease & ACSCross-sectional study
Institutional Variability in Processes of Care and Outcomes Among Patients With ST-elevation Myocardial Infarction (STEMI) in the US
- Retrospective cross-sectional study
- multicentre
- quality-improvement registry (AHA GWTG-CAD)
Authors' conclusion
In this large cross-sectional study of patients with STEMI, there was substantial hospital-level variability in achieving target treatment times. Patients in whom target FMC-to-device time was not met and those presenting to low-performing hospitals had worse outcomes.
Study context
- Population
- Patients with STEMI or STEMI equivalent undergoing primary percutaneous coronary intervention (PCI), 503 US hospitals, 2020–2022
- Participants
- 73,826 patients · 503 US hospitals
- Exposure
- Primary presentations vs Transfers
- Primary presentationsn = 60,109
- Transfersn = 13,717
- Outcome
- Site-level achievement of target FMC-to-device time (hospital performance), treatment times and in-hospital outcomes
Main finding
As reported in the abstract
Target FMC-to-device time achieved
| Group | Value | Site-level median [IQR] |
|---|---|---|
| Primary presentations | 59.5% | 60.8% [51.2%-68.8%] |
| Transfers | 50.3% | 50.0% [32.5%-66.9%] |
Observational data: associations, not effects.
Further findings
In-hospital mortality with failure to achieve target first medical contact (FMC)-to-device time
| Comparison | aOR (95% CI) | |
|---|---|---|
| Primary presentations · target not met vs met | 2.21 (2.02–2.42) | |
| Transfers · target not met vs met | 2.44 (1.90–3.12) | |
| 0.20.5125Adjusted odds ratio (log scale) |
| Outcome | aOR (95% CI) | |
|---|---|---|
| Mortality, low vs high hospital performance (primary presentations) | 1.16 (1.00–1.34) | |
| Meeting target FMC-to-device time, rural vs urban — Rural vs Urban · primary presentations | 1.20 (0.96–1.50) | |
| Meeting target FMC-to-device time, rural vs urban — Rural vs Urban · transfers | 0.86 (0.50–1.47) | |
| 0.512Adjusted odds ratio (log scale) |
Outcomes by location and primary PCI volume
- Outcomes similar between rural vs urban and low vs high primary PCI volume centers
Original publication
Institutional Variability in Processes of Care and Outcomes Among Patients With STEMI in the US. JAMA Cardiol. Published 1 August 2025. doi:10.1001/jamacardio.2025.1411
Summarised from the published abstract; every number is checked against it