Excellence in Clinical Practice Aotearoa New Zealand Out-of-Hospital STEMI Report

Hato Hone St John

The New Zealand Out-of-Hospital ST-segment Elevation Myocardial Infarction (STEMI) Pathway aims to expedite reperfusion therapy for patients attended by emergency medical services experiencing STEMI. The Aotearoa New Zealand Out-of-Hospital STEMI Pathway underwent an incremental national rollout throughout 2019 and 2020. Following the roll-out of the pathway, it was unknown how well this was implemented and if it was implemented equitably. Therefore, we aimed to evaluate the performance of the STEMI Pathway, establishing benchmarking measures and identifying areas for both clinical and operational improvements. Our evaluation was first published in 2022 as the inaugural Aotearoa New Zealand Out-of-Hospital STEMI Report (Te p–urongo STEMI –a-motu) with a subsequent update in 2023. These reports set the foundation for outof-hospital STEMI performance benchmarking in New Zealand and is the only comprehensive, annual national study of pre-hospital management of STEMI

To date, primary PCI is the preferred reperfusion strategy for patients experiencing STEMI. Nationwide, 74% of out-of-hospital STEMI cases followed the primary PCI reperfusion strategy while 13% underwent fibrinolysis. The remaining 13% did not met the criteria of either strategy.

The report shows that our pathways of care are working well, with 93% of STEMI patients undergoing primary PCI arriving at the PCI capable centre within 90 minutes of ambulance arrival. Similarly, this year’s median time from STEMI diagnosis to administration of fibrinolysis saw an over 12% improvement over last year’s measurement.

In addition to the benchmarking of key descriptive performance indicators among the two reperfusion strategies, the report also identified important trends indicating reduced access to reperfusion strategies among M–aori and socioeconomically deprived rural communities. A deep dive into this group identified a plethora of clinical and operational factors affecting access to reperfusion. While numbers among this cohort remain small at this stage, some trends are beginning to emerge, prompting the development of a nonreperfusion database for ongoing prospective analysis.