Background: The mortality reduction associated with immediate coronary reperfusion in patients with ST-elevation myocardial infarction is extensively documented. The gap between available knowledge and care delivery is primarily due to lacking coordination between the patient contact points. We postulate that the same applies to non-ST-elevation myocardial infarction (NSTEMI) and that a more consistent care delivery could improve outcomes.
Methods: We conducted a single-center retrospective observational study in NSTEMI patients who presented to the emergency department (ED) at our institution between October 2017 and September 2019, covering the last twelve months before implementing our new NSTEMI care pathway (pre-intervention) and the first twelve months thereafter (post-intervention). Primary end- point was the door-to-cardiology time, i.e., time between ED admission and admission to the cardiology department. Co-primary endpoint was the door-to-needle time, i.e., time between ED admission and initiation of coronary angiography. Secondary endpoints included total hospital stay (time between ED admission and discharge), in-hospital mortality (%), and retrospective mis- diagnoses with the coronary angiography showing no or non-relevant coronary lesions (%). Results: 271 consecutive NSTEMI patients were treated during the study period. 112 (41.3%) in the year before and 159 (58.7%) in the year after the NSTEMI care pathway implementation. NSTEMI care pathway led to a significant reduction in median door-to-cardiology time from twelve hours (interquartile range [IQR] 6–24 hours) pre-intervention to six hours (IQR 4–9 hours) post- intervention (p <0.0001); a significant reduction in median length of hospital stay from five days (IQR 3–10 days) pre-intervention to three days (IQR 2–7 days) post-intervention (p <0.0001); and a significant reduction of misdiagnoses from 16.96% pre-intervention to 8.81% post-intervention (p=0.0341). There was no significant change in median door-to-needle time (28 hours pre-inter- vention to 24 hours post-intervention, p=0.0736) nor in in-hospital mortality (0.89% pre-interven- tion versus 2.52% post-intervention, p=0.6519).
Conclusions: The NSTEMI care pathway significantly reduced door-to-cardiology time, length of hospital stay and number of misdiagnoses. It proved feasible in routine clinical practice and could be implemented on a larger scale.