Management of Acute Myocardial Infarction at St Cloud Hospital.
1998

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

 

.

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.

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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.

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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

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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%
.
.

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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.

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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%

(a) - The document were entered in the wrong area.

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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%

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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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