Table 20-8.

Timely Reperfusion for ACS and Stroke

Quality-of-Care Measure	VHA*	National Medicare and Medicaid*	GWTG- CAD†	ACTION- GWTG STEMI‡	GWTG- Stroke
ACS
tPA within 30 min	73	52	27	69	N/A
PCI within 90 min	55	86	78	90	N/A
Stroke
IV tPA in patients who arrived <2h after symptom onset§	NA	NA	NA	NA	73.1
IV tPA in patients who arrived <3h after symptom onset	NA	NA	NA	NA	67.1
No IV tPA (contraindicated/warning)	NA	NA	NA	NA	82.4

ACS indicates acute coronary syndrome; VHA, Veterans Health Administration; GWTG-CAD, Get With The Guidelines–Coronary Artery Disease; ACTIONGWTG-STEMI, Acute Coronary Treatment and Intervention Outcomes Network/Get With The Guidelines–ST-elevation myocardial infarction; tPA, tissue-type plasminogen activator; NA, not applicable; PCI, percutaneous coronary intervention; IV, intravenous.

Values are percentages.

^*Acute myocardial infarction patients.

^†GWTG-CAD: Patients admitted with a cardiovascular event. In the GWTGCAD registry, the in-hospital mortality rate was 4.5% (excludes transfer-out patients; if discharge status was missing, it was assumed to be “no.”). The mean length of hospital stay was 5.0 days (median 3.0 days).

^‡ACTION Registry: STEMI and NSTEMI patients were reported separately. Patients must have been admitted with acute ischemic symptoms within the previous 24 hours, typically reflected by a primary diagnosis of ST-elevation myocardial infarction or non–ST-elevation myocardial infarction. Patients who were admitted for any other clinical condition were not eligible.

^§Indicates 1 of the 7 key performance measures targeted in GWTG-Stroke.