Synergizing Process to Optimize Myocardial Infarction Patient Outcomes: Results of the Myocardial Infarction Delhi Primary Angioplasty Study (MIDAS).

Background: The prevalence and case fatality of ischemic heart disease in India has increased over the past 2 decades. ST-segment elevation myocardial infarction (STEMI) accounts for up to 60% of all myocardial infarctions in India, with only 25% to 40% of patients undergoing primary percutaneous coronary intervention (PPCI). A national access gap persists in India that needs to be bridged with the implementation of in-hospital processes and regional systems of collaborative care. Methods: The single-center, observational, retrospective Myocardial Infarction Delhi Primary Angioplasty Study (MIDAS) was conducted at Max Super Specialty Hospital (New Delhi, India) between January 1, 2015, and December 31, 2019. All patients presenting to the emergency department with ongoing chest discomfort suggestive of ischemia and ST elevation on electrocardiogram were included. PPCI, initiated by a "CODE STEMI" team activation call, was employed as a single reperfusion strategy to treat all patients and minimize system delays. Systematic data collection of door-to-balloon (D2B) time regular audit, feedback, and multidisciplinary team engagement was implemented to refine processes and improve efficiency. The consistency of the process in maintaining D2B time during day and night hours, as well as on weekends and holidays was evaluated. Data from the electronic health record were collected and summarized to evaluate the impact of processes on in-hospital patient outcomes. Results: A total of 887 patients meeting eligibility criteria were included in the analysis, of whom 45.2% were admitted during off hours, weekends, or holidays, and 92.3% underwent PPCI, 2.8% underwent PPCI followed by CABG, 1.8% underwent CABG, and 2.6% required medical therapy. The median D2B was 51 minutes (interquartile range, 40-60 minutes), and on holidays the mean D2B was 55 minutes (interquartile range, 40-75 minutes). The overall mortality was 5.2%. Conclusions: This study demonstrates that implementing a team-based standardized protocol can achieve guideline-recommended D2B times in a diverse STEMI population presenting to a percutaneous coronary intervention-capable hospital. Protocols reduce variation in care and enable the delivery of equitable high-quality care consistently across diverse demographic groups.