Clinical Outcomes of Fast Track Managed Care System for Acute ST Elevation Myocardial Infarction (STEMI) Patients: Chonburi Hospital Experience
Worawit Tantisiriwat MD*, Wiwat Jiar MD*, Hathaichanok Ngamkasem MD*, Suvimol Tantisiriwat RN**
Affiliation : * Department of Medicine, Chonburi Hospital, Chonburi ** Cardiac Center, Chonburi Hospital, Chonburi
Objective : To evaluate the clinical outcomes of fast track managed care system for STEMI at Chonburi
Hospital.
Material and Method: Descriptive review of clinical parameters from STEMI patients who participated in fast
track managed care system.
Results : There were 56 STEMI consecutive cases admitted to the intensive care unit (ICU) between August 1,
2006 and January 1, 2007 in the pilot project of the fast track managed care system (43 men and 13 women).
The average age was 61 years. The coronary artery disease (CAD) risk factors were smoking (66%), hypertension
(41%), diabetes mellitus (44%), and dyslipidemia (46%). The atherosclerosis diseases were chronic renal
disease (3.6%), cerebrovascular disease (7%), and peripheral vascular disease (3.6%). The average length of
stay was 5.7 days. The median door to needle time and door to balloon time were 49.8 and 130.5 minutes
respectively. Ten patients developed complications, which included gastrointestinal bleeding and ecchymosis.
The mortality rate was 26.8% (15 cases). The current medications such as ACE-I, betablocker, and dopamine
between survivors and non-survivors were compared and showed statistical significance. The creatinine and
creatine phosphokinase (CPK) were significantly different between survivors and non-survivors. There was a
decrease trend of the overall mortality rate in STEMI patients between July 2006 and January 2008 following
the launch of the fast track managed care system.
Conclusion : When compared to a previous study, the fast track system could decrease mortality rate, door to
needle time, and door to balloon time. The fast track should be included in routine hospital guideline for
management of STEMI patients.
Keywords : STEMI, Reperfusion therapy, Door to needle, Door to balloon time, Fast track
