Primary Percutaneous Coronary Intervention for Patients with St Elevation Myocardial Infarction—Past and Present at Auckland City Hospital

Abstract

Background: Primary percutaneous coronary intervention (PPCI) is the optimal reperfusion strategy for patients (pts) with ST elevation myocardial infarction (STEMI) when initiated in a timely fashion. A door-to-balloon time (DTBT) of ≤90 min is regarded as best practice. PPCI became the routine STEMI management at Auckland City Hospital (ACH) in 2006. We compare our initial and present experiences. Method: Data on all pts with STEMI admitted to ACH Coronary Care Unit (CCU) was obtained from a prospective database which included their DTBT. Results: From 1/6/2006 to 31/7/2007, there were 196 pts from ACH catchment area whose index admission was for STEMI of whom 97 (49%) had PPCI. Of these, 52 pts were “clear cut” cases, with median DTBT of 92 (IQR 74–104) min; 25 (48%) had a DTBT ≤ 90 min (figure). From 1/6/2010 to 31/7/2011, there were 208 pts from ACH catchment area whose index admission was for STEMI of whom 194 (93%) had PPCI, a 44% increase from 2006/2007 in STEMI pts who received PPCI. Of these, 117 pts were “clear cut” cases, with median DTBT of 89 (75–107) min; 61 (48%) had a DTBT ≤ 90 min. Conclusion: In 2010–2011, STEMI pts received PPCI in more than 90% of cases, compared to 2006–2007 when only half of STEMI presentations received this reperfusion strategy. However, the DTBT for pts has remained static, with only half of pts reaching the recommended time of <90 min suggesting that further improvements could still be made with service delivery.