Abstract
Introduction: Expeditious reperfusion in acute ST-elevation myocardial infarction (STEMI) with goal door-to-balloon time (DBT) &lt 90 minutes (ACC/AHA guidelines) is of utmost importance. The innovative 7-day 24-hour (24x7) in-hospital cardiac catheterization laboratory (CCL) program (24-hour in-hospital availability of an interventional cardiologist and dedicated lab staff) has been previously described by our institution. Here we present our 10-year experience on sustained gains of the program. Hypothesis: From a systems point, there is room for improvement in DBT as an integral process metric for measuring cardiovascular quality. Methods: A cohort of 1233 consecutive non-transfer STEMI patients [69.9% males (n=863), median age 61 years] presenting within 12 hours of symptom onset, formed the study population. Patients were studied for DBT, survival benefit and major adverse cardiovascular events (MACE, i.e., reinfarction, stroke, and cardiogenic shock) after primary percutaneous coronary intervention (PPCI). Using a precise protocol to allow quick entry into the CCL (door-to-CCL time) PPCI was used as the choice reperfusion strategy. Results: Median DBT was 50 minutes (interquartile range 39-67) with 91.65% of patients reperfused within the 90-minute goal. Of note, majority of the patients (66.59% n= 821) were reperfused within 60 minutes and approximately 10% of patients within 30 minutes. DBT &lt 60 minutes compared with DBT &gt 60 minutes was associated with statistically significant less in-hospital mortality (3.87 % vs. 7.66 %, p= 0.004), 1-year mortality (7.23 % vs. 12.99%, p= 0.0009) and MACE (10.7% vs. 16.01%, p= 0.0076) {(Figure 1).} Conclusions: A committed in-hospital 24x7 interventional cardiology team continues to succeed in breaking time inertia in achieving a new standard of 60 minutes. It decreases MACE and mortality in STEMI (in-hospital and 1-year) and thus justifies continued efforts to improve reperfusion times.
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