{
  "abstract": "Introduction Acute ST-segment elevation myocardial infarction (STEMI) is a life-threatening emergency, where timely reperfusion is critical for optimal outcomes. Primary percutaneous coronary intervention (PPCI) is the gold standard; however, thrombolysis is recommended when PPCI cannot be performed within 120 minutes. The introduction of the Acute Coronary Syndrome (ACS) program in 2012 prioritized PPCI, leading to a decline in thrombolysis rates. The first audit phase (2022) showed that median reperfusion times for patients transferred from hospitals outside Dublin exceeded the 120-minute target. In response, a quality improvement initiative was implemented with changes to consider thrombolysis before transfer in these cases. This audit evaluates the impact of those changes.Methods This study analysed STEMI patients admitted to St. James’s Hospital (SJH) between 01/01/2021 and 01/01/2024, comparing it with the previous audit period (2017–2020). The primary outcome was time from first ECG to reperfusion. Secondary outcomes included thrombolysis rates, thrombolysis success (TIMI 2/3 flow on initial angiography), and safety outcomes (severe bleeding).Results A total of 1,301 STEMI patients were admitted to SJH between 2021 and 2024 (1,161 from 2017–2020). Among these, 131 patients received thrombolysis. While the median time to reperfusion once again exceeded 120 minutes for patients transferred from outside Dublin, thrombolysis administration rates significantly improved. For example, St. Luke’s Hospital Kilkenny increased its thrombolysis rate from 20.1% to 61.2% ( table 1). Year-on-year thrombolysis rates have increased since 2018 (figure 1). Successful reperfusion was achieved in 85/131 (64.9%) patients who received thrombolysis. In terms of safety, 2/131 thrombolysed patients (1.5%) experienced severe bleeding events.Conclusions This quality improvement project resulted in significant improvements in STEMI care in the Dublin Mid Leinster region, particularly in thrombolysis administration for patients unable to receive timely PPCI. Continued efforts are needed to further improve reperfusion times and ensure sustained guideline adherence.Abstract 24 Table 1Time to reperfusion for STEMI patients transferred from another hospital Abbreviations: IQR: Inter-Quartile Range, ED: Emergency Department, WGH: Wexford General Hospital, SLK: St. Luke’s Kilkenny, MRHT: Midlands Regional Hospital Tullamore, MRHM: Midlands Regional Hospital Mullingar, MRHP: Midlands Regional Hospital Portlaoise, NGH: Naas General Hospital, SVUH: St Vincent’s University Hospital, TUH: Tallaght University Hospital.Abstract 24 Figure 1Yearly thrombolysis administration rates in the Dublin mid Leinster (DML) region",
  "authors": [
    {
      "affiliations": [
        "St. James’s Hospital, Dublin, Ireland"
      ],
      "name": "C Murray"
    },
    {
      "affiliations": [
        "St. James’s Hospital, Dublin, Ireland"
      ],
      "name": "J Carey"
    },
    {
      "affiliations": [
        "St. James’s Hospital, Dublin, Ireland"
      ],
      "name": "I Pearson"
    }
  ],
  "title": "24 Timely reperfusion in STEMI: a quality improvement initiative and full-cycle audit of guideline compliance in the Dublin mid Leinster region",
  "uid": "4ba07bf6-1a1f-5a4a-9465-127b84d8837a"
}