Management of Acute Myocardial Infarction at St Cloud Hospital.
1997 - 1999.

Data from National Registry of Myocardial Infarction 2 and 3 (NRMI 2-3)

To 1997
To 1998
To 1999

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1997

1998

1999

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To 1998
To 1999

 

1997

 

DATE: October 21, 1998

TO:  James E. Anderson, M,D, Richard L. Aplin, M.D, Bernard R. Ericson, M.D, Mark E. Johnson, M.D,
Richard Jolkovsky, M.D, John Mahowald, M.D, Mark J, Martone, M.D, Edgar Pineda, M.D, Timothy N. Schuchard, M.D, Marianne T. Serkland, M.D, John Teskey. M.D.

FROM: Pradub Sukhum, M.D, Juli Sanner, RN, Susan Ostendorf, RN.

RE: NRMI 2, Acute Myocardial Infarction Management at St Cloud Hospital, 1997.

 

The Central Minnesota Heart Center is pleased to present the results of acute myocardial infarction management at St Cloud Hospital in 1997. We all can be proud, as St Cloud Hospital results faired well above the national results in nearly all categories.

This report is generated from the National Registry of Myocardial Infarction database - Phase 2 (NRMI 2). All St Cloud Hospital patients with discharge diagnosis of acute myocardial infarction during the year of 1997 were included. Individual patient information was entered into the NRMI 2 computer form. These forms were sent to an independent data analysis center. Each participating hospital receives quarterly and annually report. The result from each hospital is compared to the same class hospitals ("Like Hospital"), to the same state hospitals, and to national result.

NRMI 2 had over 1600 participating hospitals and had more than 116,000 acute myocardial infarction cases registered in 1997. There are 12 hospital classes based on number of beds, availability of non-invasive, invasive, interventional and open heart surgery procedures.

 

Acute Myocardial Infarction Management at SCH in 1997, summery result
(Result from NRMI 2)

 
.
SCH
.
Like(a)
Hospitals

TOTAL PATIENTS

  
400
  
63,233
   SCH Direct Admission
.
197
49%
.
62%
   Transfer-In Patients
203
51%
.
SCH DIRECT ADMISSION  
197
  
.
   Primary PTCA
.
69
35%
.
15%
   Thrombolysis
12
6%
15%
   Neither
116
59%
70%
TRANSFER-IN  
203
  
.
   Primary PTCA
.
4
2%
.
.
   Thrombolysis at Referal Hospitals
85
42%
.
   Thrombolysis at SCH
2
1%
.
   Neither
112
55%
.

(a) 251-350 beds with intervention and open heart surgery procedures.

 

St Cloud Hospital Direct Admission, 1997

  .
SCH
197
.
Like
Hospitals
39255
(299 Centers)
DERMOGRAPHIC
.
Male  
134
68%
  
61%
Female
63
32%
39%
Age (mean years)
68
.
68
  -Male
65
.
65
  -Female
73
.
72
CLINICAL PRESENTATION
.
Sx onset to door (median minutes)  
151
163
  
130
Chest pain at presentation
149
76%
69%
ST elevation on 1st 12-lead ECG
99
50%
39%
MEDICATIONS RECEIVED WITHIN 24 HOURS
.
ASA  
189
96%
  
83%
Beta blocker, IV
55
28%
16%
Beta blocker, Oral
106
54%
40%
Heparin,IV
153
78%
76%
Nitroglycerine
134
68%
60%
Lidocaine
3
1.5%
11%
Calcium channel blocker (a)
8
4%
15%

(a) Calcium channel blocker is not recommended.

 

St Cloud Hospital Direct Admission, 1997. (continue)

  .
SCH
197
.
Like
Hospitals
39255
(299 Centers)
CLINICAL EVENTS
.
Free of adverse outcome .
129
65%
 .
51%
Recurrent ischemia
22
11%
13%
Recurrent MI
4
2%
2%
Death
.
3%
3.4%
LENGTH OF STAY (Median days)
.
All patients .
4.7
.
 .
5.5
ICU/CCU
2.0
.
2.0
MEDICATIONS AT DISCHARGE
.
ACE inhibitor .
124
67%
 .
35%
ASA
170
92%
81%
Beta blocker
147
80%
57%
Nitrate (long acting)
39
21%
46%
Calcium channel blocker
27
15%
20%
PROCEDURES PERFORMED PRIOR TO DISCHARGE
.
Coronary angiography .
150/197
76%
 .
66%
PTCA
96
49%
33%
Stent/others
22
11%
18%
CABG
17/197
9%
14%
Echocardiography
120
61%
50%
Stess test
40
20%
9%

 

Primary PTCA, 1997. (SCH Direct Admission 69/197)

 
.
SCH
69
.
Nation
10455
(607 centers)
DERMOGRAPHIC
.
Male
.
.
75%
.
69%
Female
.
25%
31%
Age (mean years)
62
.
62
  -Male
60
.
60
  -Female
69
.
67
CLINICAL PRESENTATION
.
Sx onset to door (median minutes)
.
98
.
.
105
Chest pain at presentation
.
91%
87%
ST elevation on 1st 12-lead ECG
.
87%
74%
INTERVENTION
.
Door to dilation (median minutes)
68
.
110
- From 7 am to 3 pm (33)
67
.
115
- From 3 pm to 11pm (17)
68
.
119
- From 11 pm to 7 am (18)
84
.
145
- Weekday (41)
72
.
117
- Weekend (27)
68
.
133

Patients with no chest pain at presentation has longer door to dilatation time.
In parenthesis represents number of patients.

 

Primary PTCA, 1997. (continue)

 
.
SCH
69
.
Nation
10455
(607 centers)
CLINICAL EVENTS
.
Free of adverse outcome
.
.
80%
.
54%
Recurrent ischemia
.
6%
10%
Recurrent MI
.
1%
2%
Death
.
1.4%
5.9%
LENGTH OF STAY (median days) .
All patients
.
3.9
.
.
4.1
ICU/CCU
2.0
.
2.0
ADDITIONAL PROCEDURES PERFORMED PRIOR TO DISCHARGE .
Coronary angiography .
7
10%
.
38%
PTCA
5
7%
11%
Stent/others
4
6%
39%
CABG
0
0%
5%
Echocardiography
40
58%
41%
Stress test
8
12%
6%

 

Transfer-In Patients, 1997.

 
.
SCH
203
.
Like
Hospitals
23978
DERMOGRAPHIC
.
Male
.
135
67%
.
67%
Female
68
33%
33%
Age (mean years)
64
.
63
  -Male
62
.
62
  -Female
68
.
67
CLINICAL PRESENTATION
.
Sx onset to door (median minutes)  
135
.
  
117
MEDICATIONS RECEIVED WITHIN 24 HOURS
(Combined results - both hospitals)
.
ASA
.
194
96%
.
80%
Beta blocker, IV
48
24%
15%
Beta blocker, Oral
99
49%
41%
Heparin, IV
181
89%
83%
Nitroglycerine
145
71%
67%
Lidocaine
15
7%
15%
Calcium channel blocker
4
2%
10%

 

Transfer-In Patients, 1997. (continue)

  .
SCH
203
.
Like
Hospitals
23978
CLINICAL EVENTS (both hospitals)
.
Free of adverse outcome .
.
50%
.
51%
Recurrent ischemia
.
29%
18%
Recurrent MI
.
3%
2%
Death
.
5.9
6.6%
LENGTH OF STAY (median days)
.
All patients .
4.8
.
 .
4.9
ICU/CCU
2.0
.
2.0
MEDICATIONS AT DISCHARGE
.
ACE inhibitor
.
.
68%
.
34%
ASA
.
98%
87%
Beta blocker
.
81%
60%
Nitrate (long acting)
.
17%
41%
Calcium channel blocker
.
11%
19%
PROCEDURES PERFORMED PRIOR TO DISCHARGE
.
Coronary angiography
.
175/203
86%
.
90%
PTCA
74
36%
44%
Stent/others
56
28%
28%
CABG
35/203
17%
25%
Echocardiography
100
49%
33%
Stress test
45
22%
6%

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To 1997
To 1999

 

1998

 

DATE: September 14, 1999

TO: Cardiologists, cardiac surgeons, elestrophysiologists, cardiology practice nurses, Bob Johnson, Tim Dalton, Phil Martin. Jim Gwost.

FROM: Pradub Sukhum, M.D, Susan Heying, RN.

RE: Acute Myocardial Infarction Management at SCH in 1998, a NRMI 3 Report.

 

This is the second consecutive full year report of acute myocardial infarction management at SCH. The 1998 report has more detail. It includes the results from "MN" (Minnesota) and "Nation" hospitals. Comparison is most appropriate with "Like Hospital" since data from MN and Nation Hospitals include all 16 hospital categories, with different service capability, size and patient population. St Cloud Hospital is classified in the category of >350 beds, with interventional and open heart surgery procedures.

A large number of hospitals in the United States participate in this National Registry of Myocardial Infarction (NRMI), generating a very large database. NRMI 1 started in the early 90's, then updated to NRMI 2, which ended on March 1998 in favor of NRMI 3 to follow the pattern of practice changing. The actual date in this report is from April 1, 1998 through March 31, 1999 to avoid mixing NRMI 2 and NRMI 3 data collection.

Each patient category has different results. Statistics from small sample items are likely invalid.

Please note the following:

1. Almost half of the acute myocardial infarction treated at SCH were "Transfer-In".

2. There was about 20-25% increase in SCH acute myocardial infarction patients from 1997 to 1998.

3. We performed well in:

4. We were behind in:

5. For "Direct Admission" group, we did less CABG, a little more noninvasive procedures (echocardiogram and stress test), more primary PTCA (in fact this is the initial reperfusion treatment of choice at SCH). We performed less total coronary angiographic related procedures.

 

Acute Myocardial Infarction Management at SCH in 1998(a), summery result.
(Result from NRMI 3)

 
SCH
Like Hospital
(234 Centers)
(b)
MN
(>23 Centers)
(c)
Nation
(1396 Centers)
(c)
TOTAL PATIENTS
502
63282
5524
193583
  Direct Admission
266
53%
39922
63%
4038
150514
  Transfer-In
236
47%
23360
37%
1468
43069
DIRECT ADMISSION
266
39922
.
.
  Primary PTCA
59
22%
.
15%
.
.
  IV Thrombolysis
4
2%
.
12%
.
.
  Neither
203
76%
.
73%
.
.
TRANSFER-IN
236
23360
.
.
  Primary PTCA (d)
12
5%
1440
6%
.
.
  IV Thrombolysis at 1st Hospital
93/79(e)
.
.
.
.
.
  IV Thrombolysis at SCH
0
.
.
.
.
.

(a) - NRMI 3 (4/1/98 - 3/31/99).
(b) - Like Hospital = >350 beds with Interventional, Open heart surgery.
(c) - Not all hospitals in MN or in Nation participated.
(d) - Data from 4/1/98 - 12/31/98.
(e) - First number represents total. The second number represents "eligible" patients.

 

St Cloud Hospital Direct Admission, 1998.

 
SCH
(266)
(53%)
Like Hospital
(39922)
(63%)
MN
 (4038)
(73%)
Nation
 (150514)
(77%)
DERMOGRAPHIC .
Male
164
62%
.
60%
59%
60%
Female
102
38%
.
40%
41%
40%
Age (mean years)
69
.
68
.
70
69
  - Male
66
.
65
.
67
65
  - Female
75
.
73
.
75
73
CLINICAL PRESENTATION
.
Sx to door (median minutes)
127
.
135
.
126
125
Chest pain at presentation
172
65%
.
64%
62%
65%
ST elevation and/or LBBB on 1st 12-lead ECG
86
32%
.
44%
37%
46%
Eligible patients for reperfusion Rx (a)
68
26%
.
24%
20%
23%
MODE OF THERAPY
.
Rx eligible patients with reperfusion Rx
42/68
62%
.
71%
73%
69%
IV Thrombolysis (b)
4/266
2%
.
12%
16%
19%
  - Door to drug (median minutes)
83
.
37
.
33
35
Primary PTCA
59
22%
.
15%
.
.
  - Door to dilatation (median minutes)
80
.
112
.
85
112
No reperfusion Rx
203/266
76%
.
73%
.
.
MEDICATIONS RECEIVED WITHIN 24 HOURS
.
ASA
252
95%
.
84%
86%
83%
Beta blocker
.
67%
.
52%
56%
52%
ACE inhibitor
.
38%
.
23%
28%
24%
IIb/IIIa inhibitor
.
19%
.
14%
11%
8%
Heparin
.
62% (c)
.
77%
78%
77%
Calcium channel blocker (d)
.
14%
.
14%
17%
13%

(a) - Patients with ST elevation >2 leads and/or LBBB on 1st 12 lead ECG, MI Sx onset <12 hours.
(b) - see statement on IV thrombolysis at SCH in the 1998 covered memo.
(c) - Patients undergoing primary PTCA who recieved GPIIbIIIa were not included.
(d) - Calcium channel blocker is not recommended

 

St Cloud Hospital Direct Admission, 1998. (continue)

 
SCH
(266)
(53%)
Like Hospital
(39922)
(63%)
MN
 (4038)
(73%)
Nation
 (150514)
(77%)
CLINICAL EVENTS .
Free of adverse outcome
185
70%
.
60%
59%
60%
Recurrent MI
.
2%
.
2%
2%
2%
Major bleeding
.
0.8%
.
3.5%
1.9%
2.3%
Stroke
.
0.4%
.
1.5%
1.7%
1.1%
IC hemorrhage
.
0.0%
.
0.3%
0.4%
0.2%
Thromboembolic
.
0.4%
.
0.7%
0.7%
0.8%
Length of stay (median days)
4.5
.
5.1
.
4.2
4.3
Death
26
9.8%
.
10.5%
9.6%
9.8%
DISCHAGED MEDICINES/ THERAPIES
.
ASA
.
92%
.
80%
81%
77%
Beta blocker
.
75%
.
62%
65%
59%
ACE inhibitor
.
64%
.
40%
49%
41%
Female HRT
.
13%
.
9%
12%
8%
Lipid lowering agent
.
51%
.
33%
36%
28%
Smoke cessation advice to smokers
.
58%
.
40%
44%
35%
PROCEDURES PERFORMED PRIOR TO DISCHAGE
.
Total coronary angiography and all PTCA
202
76%
.
80%
.
.
Primary PTCA
59
22%
.
15%
.
.
Coronary angiography
95
36%
.
42%
.
.
PTCA without stent
5
2%
.
5%
.
.
PTCA with stent
43
16%
.
18%
.
.
CABG
16
6%
.
12%
.
.
IIb/IIIa inhibitor
23
9%
.
5%
.
.
IABP
12
5%
.
6%
.
.
Echocardiography
142
53%
.
48%
.
.
Stress test
38
14%
.
9%
.
.

 

Primary PTCA, 1998.

 

SCH
(59)
Like Hospital
(6133)
MN
 (325)
Nation
 (12093)
DERMOGRAPHIC .
Male
43
73%
.
69%
69%
70%
Female
16
27%
.
31%
31%
31%
Age (mean years)
59
.
62
.
62
62
- Male
56
.
60
.
60
60
- Female
70
.
67
.
67
67
CLINICAL PRESENTATION
.
Sx to door (median minutes)
85
.
107
.
95
105
Chest pain at presentation
.
90%
.
86%
84%
ST elevation and/or LBBB on 1st 12-lead ECG
.
71%
.
76%
68%
76%
INTERVENTION
.
Primary PTCA (All)
59/266
22%
.
15%
.
.
Primary PTCA w/o stent
8/59
14%
.
22%
15%
23%
Primary PTCA with stent
51/59
86%
.
69%
76%
67%
IV thrombolysis and primary PTCA
0
0%
.
2%
3%
2%
IC thrombolysis
0
0%
.
< i%
0%
0%
Immediate CABG
0
0%
.
6%
5%
5%
Spontaneous reperfusion
.
.
.
2%
1%
2%
Door to dilation (median minutes)
80
.
.
112
85
112
- From 7 am to 3 pm (12) (a)
73
.
.
.
.
104
- From 3 pm to 11pm (12) (a)
88
.
.
.
.
113
- From 11 pm to 7 am (7) (a)
72
.
.
.
.
128
- Weekday (19) (a)
72
.
.
.
.
106
- weekend (12) (a)
102
.
.
.
.
122

(a) - data from 4/1/98 to 12/31/98
 Patients with no chest pain at presentation has longer door to dilatation time.
In parenthesis represents number of patients.


Primary PTCA, 1998. (continue)

 
SCH
(59)
Like Hospital
(6133)
MN
(325)
Nation
(12093)
MEDICATIONS RECEIVED WITHIN 24 HOURS
.
ASA
59
100%
.
92%
95%
91%
Beta blocker
50
85%
.
56%
73%
55%
ACE inhibitor
21
36%
.
20%
34%
20%
IIb/IIIa inhibitor
47
80%
.
56%
66%
55%
Heparin
48
81% (a)
.
92%
92%
91%
Calcium channel blocker
2
3%
.
8%
16%
9%
CLINICAL EVENTS
.
Free of adverse outcome
46
78%
.
55%
55%
55%
Recurrent MI
2
3.4%
.
2%
2%
2%
Major bleeding
2
3.4%
.
4.6%
4.5%
4.3%
Stroke
.
0%
.
1%
2.1%
0.9%
IC hemorrhage
.
0%
.
0.2%
0.3%
0.1%
Thromboembolic
.
0%
.
0.6%
0.6%
o.5%
Length of stay (median days)
3.8
.
4.1
.
4.1
4.0
Death
1/59
1.7%
.
5.6%
5.4%
5.6%
DISCHARGED MEDICATIONS/ THERAPIES
.
ASA
.
98%
.
89%
94%
90%
Beta blodker
.
86%
.
73%
83%
71%
ACE inhibitor
.
67%
.
44%
57%
43%
Female HRT (female only)
.
27%
.
11%
19%
12%
Lipid lowering agent
.
60%
.
41%
54%
39%
Smoke cessation advice to smokers
.
68%
.
46%
55%
43%

 

Transfer-In, 1998.

 
SCH
(236)
(47%)
Like Hospital
(23360)
(37%)
MN
Centers)
Nation
Centers)
THROMBOLYSIS AT 1st HOSPITAL
.
85%
.
87%
84%
86%
Sx to 1st hospital door (median minutes)
120
.
90
.
88
90
1st hospital door to drug
50
.
39
.
35
40
1st hospital door to drut < 30 minutes
.
27%
.
29%
40%
28%
INITIATED AT REGISTRY HOSPITAL
0
.
.
1%
2%
2%
1st hospital door to registry hospital door
NA
.
149
.
136
159
Registry hospital door to drug
NA
.
55
.
17
50
Sx to drug at registry hospital
NA
.
292
.
243
290
LENGTH OF STAY AND CLINICAL EVENTS
.
Days at 1st hospital
(days - median/ mean)
0.5/ 0.9
.
0.6/ 1.3
.
0.7/ 1.3
0.5/ 1.3
Days at registry hospital
4.6/ 5.6
.
4.2/ 5.8
.
4.0/ 5.9
4.1/ 5.6
Total days at 1st and registry hospital
5.1/ 6.4
.
5.5/ 7.2
.
5.2/ 7.1
5.4/ 7.0
Death at registry hospital
.
7.6%
.
6.5%
6.9%
6.3%

 

Transfer-In, 1998. (continue)

 

SCH
(236)
(47%)

Like Hospital
(23360)
(37%)
MN
(1336)
(80 Centers)
Nation
(46531)
(4856 Centers)
MEDICATIONS RECEIVED WITHIN 24 HOURS .
ASA
.
96%
.
84%
91%
83%
Beta blocker
.
71%
.
54%
66%
54%
ACE inhibitor
.
38%
.
19%
25%
19%
IIb/IIIa inhibitor
.
12%
.
10%
13%
10%
Heparin
.
84%
.
85%
90%
84%
Calcium channel blocker
.
8%
.
10%
13%
10%
DISCHARGED MEDICATIONS/ THERAPIES FROM REGISTRY HOSPITAL
.
ASA
.
94%
.
87%
89%
87%
Beta blocker
.
83%
.
65%
72%
64%
ACE inhibitor
.
71%
.
38%
46%
38%
Female HRT (female only)
.
13%
.
10%
14%
11%
Lipid lowering agent
.
54%
.
36%
45%
34%
Smoke cessation advice to smokers
.
44%
.
42%
48%
40%
PROCEDURES PERFORMED PRIOR TO DISCHARGE
.
Coronary angiography
176/236
75%
.
54%
48%
53%
PTCA without stent
.
5%
.
8%
7%
8%
PTCA with stent
.
42%
.
37%
42%
35%
CABG
.
12%
.
21%
14%
20%
IIb/IIIa IV > 24 hours
.
19%
.
12%
15%
10%
IABP
.
8%
.
8%
9%
7%
Echocardiography
.
46%
.
29%
45%
30%
Stress test
.
14%
.
6%
9%
7%

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To 1997
To 1998

 

1999

 

DATE:

TO: CMHC, ETU, CCU/ICU, Telemetry Unit, Cardiac Catheterization Laboratory.

FROM: Pradub, Sukhum, M.D, Susan Heynig, R. N.

RE: Acute Myocardial Management at SCH in 1999, a NRMI 3 Report.

 

This is the third consecutive year report for acute myocardial infarction management at SCH, which was started since 1997. It was generated from National Registry of Myocardial Infarction phase 3 (NRMI 3) data, which CMHC and SCH has been participating along with large number of centers and hospitals in the United States.

Again, CMHC-SCH continued to practice with Primary PTCA as the initial reperfusion therapy of choice, over the IV Thrombolysis.

With subsequent years, the report has increased the detail. This year report appears overwheming and the reader may have to search for the areas of particular interest. Below is the guidelines and comments to assist viewing this report:

I. Comparison is best with "Like Hospitals" (LH), with the same size and cardiologic services to SCH (251-350 beds with interventional and open heart surgery procedures). The "Minnesota Hospitals" (MN) and "Nation Hospitals" (Nation) result are from all hospitals with different cardiologic services capability.

II. There are two major patient categories: Direct admission catagory and transfer-In catagory (transfer from other less cardiologic services capability hospitals), each has its own statistics. The transfer-In patient has less detail. Note that SCH transfer-In is just barely more than 50%, some what higher than "LH", "MN" and "Nation". The total acute myocardial infarction has continued to increase for the past 3 years.

III. Primary PTCA is displayed separately as in previous year report, but this year it is also included in both Direct Admission and Transfer-In sections for better comparison with other type of therapy.

IV. SCH performed initial reperfusion treatment of the "eligible" patient at higher percentage than other centers this year. All of them were treated with primary PTCA (except one patent who was treated with IV thrombolysis). The result (ie. door to dilatation time or mortality rate of the Primary PTCA treatment group) should not come from "selected" patient.

V. Mortality rate of the ("non selected") Primary PTCA treatment patients is significantly less than other centers in the past 3 years.

VI. Door to dilatation time (median, minute) is significantly lower than other centers. Note that procedure performed during 7 am through 11pm was within 68 minutes while those during 11 pm through 7 am and during weekend was up to 102 minutes.

VII. Utilization of medications at St Cloud Hospital continues to be more appropriated, compare to other centers, for the past 3 years. Similar to the past years, we performed less CABG, more noninvasive, and not more total coronary angiographic procedures.

 

 

Acute Myocardial Infarction Management at SCH in 1999(a), summery result.
(Result from NRMI 3)

 
SCH
Like Hospital
(153 Centers)
(b)
MN
(Centers)
(c)
Nation
(1505 Centers)
(c)
TOTAL PATIENTS
535
32820
5178
20619
  Direct Admission
261
49%
20960
64%
74%
77%
  Transfer-In
274
51%
11860
36%
26%
23%
DIRECT ADMISSION
261
20960
3842
159588
  Primary PTCA
56
21%
.
16%
9%
9%
  IV Thrombolysis
1
0.4%
.
13%
15%
.18%
  Neither
204
78%
.
71%
76%
74%
TRANSFER-IN
274
11860
1336.
46531.
  Primary PTCA
10
.
.
.
.
2628
  IV Thrombolysis at 1st Hospital
83
30%
.
.
26%
27%
  IV Thrombolysis at Registry Hospital
0
0%
.
1%
0%
2%

(a) - NRMI 3 (1/1/99 - 12/31/99).
(b) - Like Hospital = 251-350 beds with Interventional, Open heart surgery.
(c) - Large number but not all hospitals in MN or in Nation participated.

 

St Cloud Hospital Direct Admission, 1999.

 
SCH
(261/535)
(49%)
Like Hospital
(20960)
(64%)
MN
 (3842)
(74%)
Nation
 (159588)
(77%)
DERMOGRAPHIC .
Male
168
64%
.
61%
58%
59%
Female
93
36%
.
39%
42%
41%
Age (mean years)
71
.
69
.
70
69
  - Male
68
.
66
.
67
66
  - Female
75
.
73
.
75
74
CLINICAL PRESENTATION
.
Sx to door (median minutes)
165
.
125
.
127
125
Chest pain at presentation
156
60%
.
66%
58%
63%
ST elevation and/or LBBB on 1st 12-lead EKG
67
26%
.
39%
32%
39%
Pre-existing CV disease
72
28%
.
41%
43%
41%
Diabetes mellitus
62
24%
.
29%
28%
30%
< 68 years
65
25%
.
26%
28%
27%
No CHF (Killip 1)
192
74%
.
75%
75%
73%
Rales, JVD (Killip 2)
51
20%
.
15%
17%
17%
Pulmonary edema (Killip 3)
17
7%
.
8%
7%
8%
Cardiogenic shock (Killip 4)
1
0%
.
2%
1%
1%

 

St Cloud Hospital Direct Admission, 1999. (continue)

 
SCH
(261/535)
(49%)
Like Hospital
(20960)
(64%)
MN
 (3842)
(74%)
Nation
 (159588)
(77%)
TREATMENT/ INTERVENTIONAL/
INITIAL REPERFUSION
 .
Eligible patients for initial reperfusion (a)
48/261
18%
.
23%
19%
20%
Treat eligible patients
42/48
88%
.
.
.
.
Treat uneligible patients
.
13%
.
23%
21%
26%
CLINICAL PRESENTATION
.
 IV thrombolysis
1/261
.
.
.
.
.
  Sx to door (median minutes)
135
.
90
.
95
90
  Door to data (median minutes)
14
.
7
.
7
7
  Data to decision
NA
.
16
.
13
15
  Dicission to drug
NA
.
10
.
11
8
  Door to drug
58
.
35
.
31
34
  Door to drug <30 minutes
.
.
.
43%
49%
45%
 Primary PTCA
56/261
.
.
.
.
.
  Sx to door (median minutes)
109
.
90
.
95
93
  Door to data
8
.
7
.
7
7
  Data to dilatation
65
.
101
.
80
96
  Door to dilatation(b)
73
.
108
.
85
104
   - From 7 am to 11 pm (33) (c)
68
.
.
.
.
97-107
   - From 11 pm to 7 am and during weekend (22) (c)
102
.
.
.
.
120
  Door to dilatation <90 minutes
.
65%
.
34%
56%
34%
LENGTH OF STAY
(median, mean days)
.
All patients
4.2, 5.6
.
4.9, 6.4
.
4.2, 5.6
4.2, 5.5
IV thrombolysis
.
.
4.8, 5.9
.
3.5, 4.2
3.3, 4.0
Primary PTCA
3.6, 4.5
.
3.9, 5.1
.
3.7, 5.0
3.9, 5.1
No reperfusion
4.5, 5.9
.
5.1, 6.7
.
4.4, 5.9
4.6, 6.0
MORTALITY
.
All patients
27/261
10.3
.
10.5%
9.8%
10.3%
IV thrombolysis
0/1
.
.
6.9%
5.3%
5.2%
Primary PTCA
0/56
0%
.
5.7%
5.9%
6.0%
No reperfusion
27/204
13.2%
.
12.2%
11.1%
12.0%

(a) - Patients with ST elevation in >2 leads and/or LBBB on 1st 12 lead ECG, MI Sx onset <12 hours.
(b) Patients with no chest pain at presentation has longer door to dilatation time.
(c) In parenthesis represents number of patients.

 

St Cloud Hospital Direct Admission, 1999. (continue)

 
SCH
(261/535)
(49%)
Like Hospital
(20960)
(64%)
MN
 (3842)
(74%)
Nation
 (159588)
(77%)
PRIMARY PTCA/ PROCEDURES
 .
PTCA without stent
5/56
9%
.
19%
10%
17%
PTCA with stent
.
91%
.
71%
76%
73%
IV Activase and PTCA
0
.
.
3%
9%
3%
IC lytic
0
.
.
0.4%
0%
<1%
Spontaneous reperfusion
0
.
.
2%
1%
2%
Immediate CABG
0
.
.
4%
4%
5%
PROCEDURES PERFORMED PRIOR TO DISCHARGE
.
Total coronary angiography
185/261
71%
.
81%
43%
50%
Primary PTCA
56
21%
.
16%
9%
9%
 - Without stent
.
9%*
.
19%*
14%
17%
 - With stent
.
91%
.
71%
76%
73%
Coronary angiography (a)
94
36%
.
41%
18%
29%
PTCA
35
13%
.
24%
16%
12%
 - Without stent
1
0.4%
.
4%
2%
2%
 - With stent
34
13%
.
20%
14%
10%
CABG
20
8%
.
12%
6%
6%
 - Immediate/primary PTCA
0
.
.
5%
4%
5%
 - Immediate/all direct admission
0
.
.
1%
.
.
IABP
16
6%
.
6%
4%
3%
Echocardiography
143
55%
.
48%
59%
51%
Stress test
42
16%
.
8%
12%
9%

(a) This category does not include procedures relate to Primary PTCA

 

St Cloud Hospital Direct Admission, 1999. (continue)

 
SCH
(261/535)
(49%)
Like Hospital
(20960)
(64%)
MN
 (3842)
(74%)
Nation
 (159588)
(77%)
CLINICAL EVENTS .
All patients
261
.
20960
.
3842
159588
 Free of adverse outcome
192
74%
.
50%
43%
51%
 Recurrent MI
7
3%
.
2%
2%
2%
 Major bleeding
0
0.0%
.
3.8%
2.5%
2.6%
 Stroke
4
1.5%
.
1.0%
1.3%
1.0%
 IC hemorrhage
0
0.0%
.
0.2%
0.1%
0.2%
 Thromboembolic
3
1.1%
.
0.5%
0.8%
0.4%
IV thrombolysis
1
.
2701
.
562
28036
 Free of adverse outcome
1
.
.
50%
42%
52%
 Recurrent MI
.
.
.
3%
3%
3%
 Major bleeding
.
.
.
4.9%
2%
2.6%
 Stroke
.
.
.
1.4%
1.6%
1.3%
 IC hemorrhage
.
.
.
0.9%
0.2%
0.8%
 Thromboembolic
.
.
.
0.3%
0.4%
0.2%
Primary PTCA
56
.
3326
.
355
13681
 Free of adverse events
49
88%
.
56%
54%
56%
 Recurrent MI
1
2%
.
1%
1%
1%
 Major bleeding
0
0%
.
4.7%
4.8%
4.6%
 Stroke
0
0%
.
0.4%
0.8%
0.7%
 IC hemorrhage
0
0%
.
0.1%
0%
0.1%
 Thromboembolic
0
0%
.
0.3%
0.8%
0.4%
No initial reperfusion
204
.
.
.
.
.
 Free of adverse events
142
70%
.
49%
42%
50%
 Recurrent MI
6
3%
.
2%
1%
1%
 Major bleeding
0
0%
.
3.3%
2.3%
2.4%
 Strroke
4
2.0%
.
1.1%
1.3%
1.0%
 IC hemorrhage
0
0%
.
0.1%
0.1%
0.1%
 Thromboembolic
3
1.5%
.
0.6%
0.8%
0.5%

 

St Cloud Hospital Direct Admission, 1999. (continue)

 
SCH
(261/535)
(49%)
Like Hospital
(20960)
(64%)
MN
 (3842)
(74%)
Nation
 (159588)
(77%)
MEDICINES RECEIVED WITHIN 24 HOURS .
All patients
261
20960
3842
159588
 ASA
240
92%
.
85%
87%
83%
 Beta blocker
170
65%
.
52%
59%
54%
 ACE inhibitor
90
34%
.
23%
29%
24%
 IIb/IIIa
61
23%
.
21%
17%
13%
 Heparin
141
54% (a)
.
79%
76%
72%
 Calcium channel blocker (b)
32
12%
.
13%
16%
13%
IV thrombolysis
1
2701
562
28036
 ASA
.
.
.
96%
97%
94%
 Beta blocker
.
.
.
66%
71%
67%
 ACE inhibitor
.
.
.
19%
21%
19%
 IIb/IIIa
.
.
.
18%
12%
9%
 Heparin
.
.
.
97%
96%
96%
 Calcium channel blocker
.
.
.
5%
3%
4%
Primary PTCA
56
3326
355
13681
 ASA
55
98%
.
92%
96%
91%
 Beta blocker
38
68%
.
56%
69%
58%
 ACE inhibitor
18
32%
.
19%
30%
20%
 IIb/IIIa
52
93%
.
67%
76%
67%
 Heparin
39
70% (a)
.
91%
89%
91%
 Calcium channel blocker
1
2%
.
9%
15%
8%
No initial reperfusion
204
14933
2925
117871
 ASA
184
90%
.
82%
84%
80%
 Beta Blocker
131
64%
.
48%
56%
51%
 ACE inhibitor
72
35%
.
25%
30%
25%
 IIb/IIIa
9
4%
.
11%
10%
8%
 Heparin
101
50% (a)
.
73%
71%
71%
 Calcium channel blocker
31
15%
.
16%
18%
15%

(a) Patients undergoing primary PTCA who recieved GPIIbIIIa were not included.

 

St Cloud Hospital Direct Admission, 1999. (continue)

 
SCH
 (261/535)
(49%)
Like Hospital
(20960)
(64%)
MN
 (3842)
(74%)
Nation
 (159588)
(77%)
DISCHARGED MEDICATIONS/ THERAPIES
.
All patients
229
.
17969
.
2722
101295
 ASA
207
90%
.
82%
83%
77%
 Beta blocker
185
81%
.
63%
69%
63%
 ACE inhibitor
139
61%
.
39%
47%
41%
 Lipid lowering agent
120
52%
.
35%
42%
33%
 Female HRT (female only)
.
12%
.
10%
12%
8%
 Smoke cessation advice to smokers
.
29%
.
43%
53%
40%
IV thrombolysis
1
.
2333
.
302
12121
 ASA
.
.
.
90%
89%
87%
 Beta blocker
.
.
.
74%
76%
75%
 ACE inhibitor
.
.
.
37%
46%
40%
 Lipid lowering agent
.
.
.
42%
58%
43%
 Female HRT (female only)
.
.
.
10%
14%
10%
 Smoke cessation advice to smokers
.
.
.
46%
55%
45%
Primary PTCA
56
.
3326
.
355
13681
 ASA
55
98%
.
90%
95%
90%
 Beta blocker
45
80%
.
73%
83%
76%
 ACE inhibitor
41
73%
.
41%
55%
43%
 Lipid lowering agent
29
52%
.
45%
59%
47%
 Female HRT (female only)
2
13%
.
12%
20%
12%
 Smoke cessation advice to smokers
.
33%
.
48%
64%
48%
No initial reperfusion
172
.
.
.
.
.
 ASA
151
88%
.
78%
80%
74%
 Beta blocker
139
81%
.
58%
66%
58%
 ACE inhibitor
97
56%
.
38%
45%
40%
 Lipid lowering agent
90
52%
.
32%
37%
29%
 Female HRT (female)
8
12%
.
9%
11%
7%
 Smoke cessation advice to smokers
.
26%
.
40%
48%
36%

 

Primary PTCA, St Cloud Direct Admission, 1999.

 

SCH
(56)
Like Hospital
(3326)
MN
(355)
Nation
(13681)
INTERVENTION
.
Primary PTCA (All)
56/261
21%
.
15%
.
.
Primary PTCA w/o stent
5/56
9%
.
19%
10%
17%
Primary PTCA with stent
51/56
91%
.
71%
76%
73%
IV thrombolysis and primary PTCA
0
0%
.
3%
0%
3%
IC thrombolysis
0
0%
.
0.4%
0%
<1%
Immediate CABG
0
0%
.
4%
4%
5%
Spontaneous reperfusion
.
.
.
2%
1%
2%
Sx to door (median minutes)
109
.
90
.
95
93
Door to data
8
.
7
.
7
7
Data to dilatation
65
.
101
.
80
96
Door to dilation (median minutes) (a)
73
.
108
.
85
104
- From 7 am to 3 pm (22)
68
.
.
.
.
97
- From 3 pm to 11 pm (11)
68
.
.
.
.
107
- From 11pm to 7 am (8)
102
.
.
.
.
120
- Weekday (27)
68
.
.
.
.
99
- Weekend (14)
102
.
.
.
.
117
Door to dilatation <90
.
65%
.
34%
56%
34%

(a) Patients with no chest pain at presentation has longer door to dilatation time.
(b) In parenthesis represents number of patients.

 

Primary PTCA, St Cloud Hospital Admission, 1999. (continue)

 
SCH
(56)
Like Hospital
(6133)
MN
(325)
Nation
(12093)
MEDICATIONS RECEIVED WITHIN 24 HOURS
.
ASA
55
98%
.
92%
96%
91%
Beta blocker
38
68%
.
56%
69%
58%
ACE inhibitor
18
32%
.
19%
30%
20%
IIb/IIIa inhibitor
52
93%
.
67%
76%
67%
Heparin
39
70% (a)
.
91%
89%
91%
Calcium channel blocker
1
2%
.
9%
15%
8%
CLINICAL EVENTS
.
Free of adverse outcome
49
88%
.
56%
54%
56%
Recurrent MI
1
2%
.
1%
1%
1%
Major bleeding
0
0%
.
4.7%
4.8%
4.6%
Stroke
0
0%
.
0.5%
0.8%
0.7%
IC hemorrhage
0
0%
.
0.1%
0%
0.1%
Thromboembolic
0
0%
.
0.6%
0.6%
o.5%
Length of stay (median days)
3.8
.
4.1
.
4.1
4.0
Death
0/56
0%
.
5.7%
5.9%
6.0%
DISCHARGED MEDICATIONS/ THERAPIES
.
ASA
55
98%
.
90%
95%
90%
Beta blodker
45
80%
.
73%
83%
76%
ACE inhibitor
41
73%
.
41%
55%
43%
Female HRT (female only)
(2)
(13)%
.
(12%)
(20%)
(12%)
Lipid lowering agent
29
52%
.
45%
59%
47%
Smoke cessation advice to smokers
6/18
33%
.
48%
64%
48%

(a) Patients undergoing primary PTCA who recieved GPIIbIIIa were not included.

 

Transfer-In, 1999.

(a), (b)
SCH
(274/535)
(51%)
(>22 of 1st Hosp)
Like Hospital
(11860/32820 )
(36%)
MN
(1336)
(>80 Centers)
Nation
(46531)
(>4856 Centers)
THROMBOLYSIS AT 1st HOSPITAL
83/274
30% (c)
.
.
26%
27%
Sx to 1st hospital door (median minutes)
93
.
85
.
80
85
1st hospital door to drug
40
.
37
.
34
35
1st hospital door to drut < 30 minutes
.
38%
.
40%
46%
41%
Sx onset to drug
144
.
131
.
121
131
INITIATED AT REGISTRY HOSPITAL
0
.
.
1%
0
2%
Sx onset to 1st hospital door
NA
.
110
.
N/A
109
1st hospital door to registry hospital door
NA
.
180
.
N/A
171
Registry hospital door to drug
NA
.
46
.
N/A
50
Registry hospital door to drug < 30 minutes
0%
.
.
30%
0%
31%
Sx onset to drug at registry hospital
NA
.
302
.
N/A
324
LENGTH OF STAY AND CLINICAL EVENTS (d), (e)
.
Days at 1st hospital
(days - median, mean)
0.5, 1.0
.
0.5, 1.1
.
0.6, 1.2
0.5, 1.2
Days at registry hospital, all patients
4.3, 6.0
.
4.1, 5.7
.
3.9, 5.6
4.0, 5.6
Total days at 1st and registry hospital
5.1, 7.0
.
5.2, 6.9
.
4.9, 6.7
5.2, 6.8
Death at registry hospital
20
7.3%
.
5.8%
6.1%
6.3%

(a) Range: (1) Sx onset to 1st Hospital door (initiated at 1st or Registry Hospital) = 0 to 4320 minutes (72 hours). (2) 1st Hospital door to drug (initiated at 1st Hospital of Registry Hospital) = 0 - 1440 minutes (24 houra). (3) Sx onset to drug (initiated at 1st or Registry Hospital) = 0 - 1440 minutes (24 hours). (4) 1st Hospital door to Registry door = 0 to 10 days. (b) Patients excluded from analysis: (1) Prehospital thrombolysis admistration. (2) MI Sx onset after 1st Hospital arrival. (3) No ST elevation and/or LBBB on 1st 12-lead ECG results. (4) any interval with a missing value. (c) Include patients did not meet standard initial reperfusion criteria.
(d) 0.1 day = 2.4 hours. (e) Range: (1) Length of stay at 1st Hospital = 0 to 10 days. (2) Length of stay at Registry Hospital = 0 to 365 days. (3) Total, 1st and Registry Hospital = 0 to 365 days.

 

Transfer-In, 1999. (continue)

 
SCH
(274/535)
(51%)
(>22 of 1st Hosp)
Like Hospital
(11860/32820)
(36%)
MN
(1336)
(>80 Centers)
Nation
(46531)
(>4856 Centers)
MEDICATIONS RECEIVED WITHIN 24 HOURS .
ASA
267
97%
.
83%
95%
85%
Beta blocker
201
73%
.
56%
69%
58%
ACE inhibitor
105
38%
.
20%
27%
20%
IIb/IIIa
28
10%
.
17%
18%
18%
Heparin
225
82%
.
85%
91%
86%
Calcium channel blocker
28
10%
.
17%
12%
10%
DISCHARGED MEDICATIONS/ THERAPIES FROM REGISTRY HOSPITAL
.
ASA
241
97%
.
89%
91%
88%
Beta blocker
215
87%
.
69%
78%
69%
ACE inhibitor
151
61%
.
37%
46%
39%
Female HRT (female only)
14
17%
.
12%
18%
12%
Lipid lowering agent
155
63%
.
43%
50%
43%
Smoke cessation advice to smokers
25/69
36%
.
43%
55%
46%
PROCEDURES PERFORMED PRIOR TO DISCHARGE (a)
.
Coronary angiography (b)
.
72%
.
50%
42%
50%
PTCA without stent (c)
.
2%
.
5%
4%
5%
PTCA with stent (d)
.
33%
.
42%
44%
38%
CABG
.
15%
.
23%
13%
20%
IIb/IIIa IV > 24 hours
.
14%
.
13%
17%
15%
IABP
.
4%
.
8%
8%
7%
Echocardiography
.
49%
.
29%
45%
31%
Stress test
.
22%
.
5%
11%
6%

(a) Patients receiving multiple procedures of the same category are only count once.
(b) Coronary angiography should be marked when this procedure is performed alone and not in conjunction with an initial reperfusion strategy.
(c) PTCA without stent (excluding Primary PTCA) = elective PTCA without stent and/or rescue PTCA without stent.
(d) PTCA with stent (excluding Primary PTCA) = elective PTCA with stent and/or rescue PTCA with stent.

 

Primary PTCA, Transfer-In, 1999.
Number of patients at SCH is small. Statistical analysis may be invalid.

 
SCH
(10/274)
(>22 of 1st Hosp)
Like Hospital
MN
Nation
(2628/ 46531)
(>4856 Centers)
DERMOGRAPHIC .
Male
9/10
90%
.
.
.
68%
Female
.
10%
.
.
.
32%
Age (mean years)
60
.
.
.
.
62
 - Male
58
.
.
.
.
60
 - Female
79
.
.
.
.
66
CLINICAL PRESENTATION
.
No CHF (Killip 1)
9
90%
.
.
.
82%
Rales, JVD (Killip 2)
.
10%
.
.
.
7%
Pulmonary edama (Killip 3)
.
0%
.
.
.
2%
Cardiogenic shock (Killip 4)
.
0%
.
.
.
5%
LENGTH OF STAY AND CLINICAL EVENTS
.
Days at 1st Hospital
(days -median,mean)
0.2, 0.4
.
.
.
.
0.1, 0.3
Days at Registry Hospital, all patients
3.9, 3.8
.
.
.
.
3.6, 4.9
Total days at 1st and Registry Hospital
4.3, 4.0
.
.
.
.
3.8, 5.1
Death at Registry Hospital
0%
.
.
.
.
7%

 

Primary PTCA, Transfer-In, 1999. (continue)
Number of patients at SCH is small. Statistical analysis may be invalid.

 
SCH
(10/274)
(>22 of 1st Hosp)
Like Hospital
MN
Nation
(2628/ 46531)
(>4856 Centers)
MEDICATIONS RECEIVED WITHIN 24 HOURS OF MI Dx .
ASA
10
100%
.
.
.
89%
Beta blocker (oral or IV)
.
90%
.
.
.
58%
ACE inhibitor
.
50%
.
.
.
20%
IIb/IIIa
.
70%
.
.
.
64%
Heparin (including LMWH)
.
100%
.
.
.
91%
Calcium channel blocker
.
10%
.
.
.
9%
DISCHARGED MEDICATIONS/ THERAPIES (from Registry Hospital)
.
ASA
.
100%
.
.
.
90%
Beta blocker
.
90%
.
.
.
75%
ACE inibitor
.
60%
.
.
.
45%
Female HRT (female only)
.
0%
.
.
.
13%
Lipid lowering agent
.
50%
.
.
.
45%
Smoking cessation advice to smokers
.
40%
.
.
.
50%
PRIMARY PTCA PATIENTS Receiving Procedures Prior to Discharge
.
Subsequent coronary angiography
.
0%
.
.
.
23%
Elective PTCA without stent
.
0%
.
.
.
1%
Elective PTCA with stent
.
0%
.
.
.
5%
CABG (excluding immediate)
.
0%
.
.
.
6%
IV IIb/IIIa inhibitor >24 hrs
.
0%
.
.
.
5%
IABP
.
0%
.
.
.
15%
Echocardiography
.
70%
.
.
.
37%
Stress test
.
10%
.
.
.
3%

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To 1999