Systems of care to improve timeliness of reperfusion therapy for ST-segment elevation myocardial infarction during off hours: the Mayo Clinic STEMI protocol

JACC Cardiovasc Interv. 2008 Feb;1(1):88-96. doi: 10.1016/j.jcin.2007.10.002.


Objectives: We implemented the Mayo Clinic ST-segment elevation myocardial infarction (STEMI) protocol and evaluated the timeliness of reperfusion therapy during off hours versus regular hours.

Background: Patients with STEMI who present during off hours have longer door-to-balloon times and door-to-needle times.

Methods: The Mayo STEMI protocol was implemented in May 2004 to optimize timeliness of reperfusion therapy for STEMI patients presenting to Saint Mary's Hospital, a tertiary facility with on-site percutaneous coronary intervention (PCI), and for those presenting to 28 regional hospitals located up to 150 miles away from Saint Mary's Hospital. We compared door-to-balloon times and door-to-needle times for 597 consecutive patients who presented during off hours (weekdays from 5 pm to 7 am and any time on weekends or holidays) versus regular hours (weekdays from 7 am to 5 pm). In 2003, prior to implementing the protocol, median door-to-balloon time at Saint Mary's Hospital was 85 min during regular hours and 98 min during off hours.

Results: Among 258 patients who presented to Saint Mary's Hospital, median door-to-balloon time was 65 min during regular hours versus 74 min during off hours (p = 0.085). Among 105 patients transferred from regional hospitals for primary PCI, median door-to-balloon time was 118 min during regular hours versus 114 min during off hours (p = 0.15). Among 131 patients treated with fibrinolytic therapy at regional hospitals, median door-to-needle time was 21 min during regular hours versus 26 min during off hours (p = 0.067).

Conclusions: The Mayo Clinic STEMI protocol demonstrates the rapid times that can be achieved through coordinated systems of care for STEMI patients presenting during off hours and regular hours.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Angioplasty, Balloon, Coronary / methods*
  • Electrocardiography*
  • Female
  • Fibrinolytic Agents / therapeutic use*
  • Follow-Up Studies
  • Humans
  • Inpatients*
  • Male
  • Middle Aged
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / physiopathology
  • Myocardial Infarction / therapy*
  • Myocardial Reperfusion / methods*
  • Prospective Studies
  • Time Factors
  • Treatment Outcome


  • Fibrinolytic Agents