Acute coronary syndromes clinical care standard indicators: 3c-Proportion of patients with ST-segment-elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI) within 90 minutes of first clinical contact, 2019-

Collection and usage attributes

"First clinical contact" is defined as a paramedic or nurse who can administer fibrinolysis.

Both the numerator and the denominator include patients with STEMI.

For the numerator, patients undergoing PCI include those for which one of the following Episode of admitted patient care—procedure, code (ACHI 11th edn) NNNNN-NN is recorded:

• 38300-00 [670] Percutaneous transluminal balloon angioplasty of 1 coronary artery
• 38303-00 [670] Percutaneous transluminal balloon angioplasty of >=2 coronary arteries
• 38306-00 [671] Percutaneous insertion of 1 transluminal stent into single coronary artery
• 38306-01 [671] Percutaneous insertion of >= 2 transluminal stents into single coronary artery
• 38306-02 [671] Percutaneous insertion of >= 2 transluminal stents into multiple coronary arteries.

The denominator excludes patients for whom PCI is contraindicated (where the contraindication is documented in their medical record). Contraindications for PCI and fibrinolysis may include advance care directives, being on a palliative care pathway, and clinical judgement, subject to discussion with patients, family and carers.

For patients first seen by a paramedic who can administer fibrinolysis, time of first clinical contact is the time the paramedic first saw the patients. For those patients who are NOT seen been a paramedic who can administer fibrinolysis, time of first clinical contact is the time of presentation at hospital. Or in the case where the patient is transfered from a non-PCI capable hospital, the time of presentation at the first hospital.

Presented as a percentage.

(Numerator ÷ denominator) x 100

Number of patients with STEMI, treated with PCI, within 90 minutes of first clinical contact.

Number of patients with STEMI who arrive at a PCI-capable hospital or are transferred from a non PCI‑capable hospital.

It is recognised that this target of 90 minutes is difficult to achieve in the management of patients with STEMI who suffer a cardiac arrest, and for whom advanced resuscitation is effected prior to PCI.

Representational attributes

N[NN]

Source and reference attributes

Australian Commission on Safety and Quality in Health Care

National Heart Foundation of Australia & Cardiac Society of Australia and New Zealand 2016 Executive Working Group 2016. Australian clinical guidelines for the management of acute coronary syndromes 2016. Heart, Lung, and Circulation 25: 895-951.