{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T03:44:46Z","timestamp":1785728686454,"version":"3.56.0"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,5,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Most US patients with ST\u2010segment\u2013elevation myocardial infarction (STEMI) transferred for percutaneous coronary intervention (PCI) do not achieve the goal door\u2010to\u2010balloon time (D2BT) of \u2264120 minutes. We evaluated the impact of a comprehensive STEMI protocol (CSP) implemented in our health care system on STEMI process metrics in patients transferred for PCI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods AND RESULTS<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      The CSP is a 4\u2010step protocol including (1) emergency department (ED) cardiac catheterization laboratory activation; (2) a STEMI Safe Handoff Checklist; (3) immediate transfer to an available cardiac catheterization laboratory; and (4) radial\u2010first approach to PCI. We compared the use of guideline\u2010directed medical therapy before angiography, radial\u2010first access, and D2BT in 1274 consecutive patients with STEMI transferred to our hospital for PCI before (pre\u2010CSP group; January 1, 2011, to July 14, 2014) and after (CSP group; July 15, 2014, to July 15, 2019) CSP implementation. The study population included 499 patients in the pre\u2010CSP group and 775 patients in the CSP group. After CSP implementation, guideline\u2010directed medical therapy before angiography (84.6% versus 93.9%,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001) and radial access (19.0% versus 77.7%,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001) both increased significantly. Median D2BT decreased from 114 (interquartile range, 94\u2013146 minutes) to 97 minutes (interquartile range, 82\u2013115 minutes;\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001) after CSP implementation, with substantially more patients treated with D2BT of \u2264120 minutes (55.7% versus 80.1%,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001). Achievement of D2BT &lt;120 minutes in the CSP group was associated with a 50% relative risk reduction in the 30\u2010day mortality rate (odds ratio, 0.50;\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.04) and an absolute risk reduction of 0.7%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">In patients with STEMI transferred for PCI, a standardized protocol for STEMI care was associated in improvements in key process metrics (guideline\u2010directed medical therapy, radial access, and D2BT) with associated reduction in the 30\u2010day mortality rate.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.123.034054","type":"journal-article","created":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T07:58:24Z","timestamp":1746172704000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Association of a Comprehensive ST\u2010Segment\u2013Elevation Myocardial Infarction Protocol With Key Process Metrics Among Patients Transferred for Primary Percutaneous Coronary Intervention"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0619-426X","authenticated-orcid":false,"given":"Radoslav","family":"Zinoviev","sequence":"first","affiliation":[{"name":"University of California Los Angeles","place":["Los Angeles, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4413-5439","authenticated-orcid":false,"given":"Anirudh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Northwestern Central DuPage 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W.","family":"Reed","sequence":"additional","affiliation":[{"name":"Vascular and Thoracic Institute","place":["Cleveland, USA"]},{"name":"Vascular and Thoracic Institute Center for Healthcare Delivery Innovation","place":["Cleveland, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6048-7955","authenticated-orcid":false,"given":"Amar","family":"Krishnaswamy","sequence":"additional","affiliation":[{"name":"Vascular and Thoracic Institute","place":["Cleveland, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damon Michael","family":"Kralovic","sequence":"additional","affiliation":[{"name":"Vascular and Thoracic Institute Center for Healthcare Delivery Innovation","place":["Cleveland, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fredric M","family":"Hustey","sequence":"additional","affiliation":[{"name":"Vascular and Thoracic Institute Center for Healthcare Delivery 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