Institutional Variability in Processes of Care and Outcomes Among Patients With ST-elevation Myocardial Infarction (STEMI) in the US
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 patients503 US hospitals
- Exposure
- Target first medical contact (FMC)-to-device time met vs not met; hospital performance, location and primary PCI volume
- 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
Methodological detailsmulticentre, quality-improvement registry (AHA GWTG-CAD)
- Multicentre
- Quality-improvement registry (AHA GWTG-CAD)
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%] |
Value
Primary presentations59.5%
Transfers50.3%
Site-level median [IQR]
Primary presentations60.8% [51.2%-68.8%]
Transfers50.0% [32.5%-66.9%]
Observational data: associations, not effects.
Further findings
In-hospital mortality with failure to achieve target FMC-to-device time
| aOR (95% CI) | ||
|---|---|---|
| Primary presentationsTarget not metvs met | 2.21 (2.02–2.42) | |
| TransfersTarget not metvs met | 2.44 (1.90–3.12) | |
| 0.20.5125Adjusted odds ratio (log scale) |
| Outcome | aOR (95% CI) | |
|---|---|---|
| Mortality, lowvs high hospital performance (primary presentations) | 1.16 (1.00–1.34) | |
| Meeting target FMC-to-device time, rural vs urbanRuralvs UrbanPrimary presentations | 1.20 (0.96–1.50) | |
| Meeting target FMC-to-device time, rural vs urbanRuralvs UrbanTransfers | 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.
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