Marin General Hospital’s Success in Coronary Angioplasty – Top Marks, Dramatic Case of San Rafael Woman Tell the Story

A nationwide cardiac data registry has found that Marin General Hospital ranks in the top tier of hospitals in using coronary angioplasty – including ranking in the 100th percentile for “angiographic success” for the year 2007.

The National Cardiovascular Data Registry* by the American College of Cardiology Foundation, which performs the only comparative analysis of the nation’s angioplasty programs, examined the performance of more than 600 hospitals according to 10 measurements of success in 2007. (In angioplasty, a probe is inserted into an artery and threaded to the heart, where a tiny balloon and mesh stent are used to push back plaque blocking the artery and restore blood flow to the heart.)

MGH ranked in the 80th percentile or above in three of the 10 measurements, considered “top indicators” by cardiologists. These measurements are particularly critical in gauging the success of a cardiac catheterization program, said cardiologist Brian L. Strunk MD. (A ranking in the 80th percentile means MGH outperformed 80 percent of reporting hospitals.)

The success of MGH’s cardiac catheterization program, which works in close partnership with Marin paramedics, was demonstrated in human terms on July 10 when a 59-year-old San Rafael woman was brought back to life three times after a massive heart attack, then had her totally blocked “widowmaker” artery cleared within 30 minutes of arriving at the hospital.

Sharon Pelletier, a waitress at Izzy’s Steaks & Chops in Corte Madera, experienced symptoms of a heart attack during the lunch shift. Corte Madera firefighter-paramedics arrived quickly and restarted Pelletier’s heart twice while transporting her to MGH. Emergency Department personnel restarted her heart a third time.

Thirty minutes after arrival at MGH, she had been taken to the hospital’s Cardiac Catheterization Lab, where Dr. Strunk employed angioplasty to open a totally blocked artery.

“Without the outstanding work of the paramedics and the emergency angioplasty, Sharon would not have made it,” said Dr. Strunk after the procedure. “In this case we did significantly better than the national target of opening blocked arteries within 90 minutes of the patient’s arrival at the hospital.”

The three top indicators cited in the National Cardiovascular Data Registry, and MGH’s performance, are:


  • "Angiographic success," defined as the number of cases in which artery blockages were reduced to no more than 20 percent, MGH ranked in the 100th percentile of 781 hospitals reporting.

  • The amount of time needed to open blocked arteries once a patient arrives at the hospital. MGH ranked in the 80th percentile, with 82.1 percent of patients receiving this critical treatment within the first 90 minutes.

  • "Risk-adjusted mortality." The hospital's 0.59 percent mortality rate placed it in the 91st percentile when compared with 717 hospitals.


“These results show what an outstanding program we have in Marin County,” said Dr. Strunk. “We started our coronary angioplasty program a decade ago and were one of the first hospitals in Northern California to offer angioplasty services for heart-attack patients. These results show what an experienced and committed staff can do in a very difficult situation.”

MGH was the first Marin County-certified STEMI receiving and treatment center. (STEMI is a term that refers to the most acute form of heart attack.) The hospital’s success in establishing this center resulted in Dr. Strunk being named to a statewide panel whose goal is to bring other California hospitals up to STEMI center standards.

The amount of time it takes to open blocked arteries once a patient arrives at the hospital is a key measurement, as cardiologists consider the first 90 minutes after arrival at the hospital as being the “golden window.” Opening blocked arteries during this time vastly increases a person’s chance of recovering from the heart attack, and decreases the chance that he or she will die.

By treating 82.1 percent of patients within the first 90 minutes, MGH outperformed 80 percent of all hospitals reporting in this measurement.
“The seven other measurements reported in the American College of Cardiology Foundation survey are not as clinically significant as the three top indicators,” Dr. Strunk said.

These measured MGH’s performance related to bleeding incidents; length of hospital stay; number of stents used per procedure; number of patients prescribed a stroke-preventing drug; frequency of angioplasty when it was later determined that the procedure was not needed; and success in opening arteries without significant adverse effects. MGH’s scores in these measurements all met or exceeded national norms.

In a separate study of Medicare patients who underwent coronary angioplasty, MGH logged a perfect score. Of 21 Medicare-eligible patients treated from October 2006 to June 2007, 100 percent had blocked arteries opened within 90 minutes of arriving at the hospital, according to the U.S. Department of Health and Human Service’s Hospital Compare website, www.hospitalcompare.hhs.gov/. (Because the number of patients was below the statistical threshold of 25, Medicare does not consider MGH’s score to be “statistically significant.”)

Said Dr. Strunk, “Taken together, the results of these two surveys confirm the value of our ongoing commitment to providing the best possible cardiac care to our Marin neighbors.”

* Source: “American College of Cardiology – National Cardiology Data Registry: PCI and Diagnostic Catheterization Registry Metrics,” covering data from all of 2007.

August 8, 2008