Management of Acute Myocardial Infarction at St Cloud Hospital.
1997

Data from National Registry of Myocardial Infarction 2 (NRMI 2)

 

.

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.

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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.

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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.

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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%

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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.

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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%

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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%

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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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