PW112 Use of Intensive Lipid-lowering Therapy in Patients Hospitalized with Acute Coronary Syndrome in Dubai, United Arab Emirates

Abstract

Introduction: Improved door to balloon times (DBT) correlate with better outcomes for patients with ST Elevation Myocardial Infarctions (STEMIs). In order to improve the DBT at St George Hospital, a tertiary referral centre providing 24-hour primary coronary angioplasty, a Pre-hospital Ambulance activation of Primary Angioplasty (PAPA) commenced in June 2011. This coincided with re-installation of the second catheter laboratory, which had been non-functional for 6 months. Objectives: We sought to assess the impact on DBT of, firstly, the implementation of the PAPA system and secondly the availability of a second laboratory for presentations that occur ‘in hours’ (08:00 – 17:00). Methods: Data is routinely collected using a standardized form and securely stored for every STEMI. Retrospective analysis was conducted for each STEMI patient who presented in the 15 months before and after PAPA implementation. ‘In hours’ data was reviewed for the six months pre and post the second laboratory re-installation. ‘Door to balloon time’ (DBT) was defined as ‘time of emergency triage’ to ‘time of balloon inflation’ for all presentations except PAPA cases where DBT was defined as the ‘time of ambulance arrival’ to ‘time of balloon inflation’. Results: Populations were similar with an average age pre and post PAPA of 64 years. Male patients accounted for 74% of the population pre PAPA and 78% in the post PAPA period. There were 75 STEMIs with an average DBT of 93minutes in the 15 months prior to PAPA implementation and 96 STEMIs (68 non-PAPA and 28 PAPA cases) with an average DBT of 67 minutes (78 and 41 minutes respectively) in the 15 months post. DBT improved on average by 26 minutes (15 minutes for non PAPA cases and 52 minutes for PAPA cases). For PAPA cases DBT decreased by 56% (p<0.05). In the 6 months prior to PAPA 14 of the 33 STEMIs occurred ‘in hours’ with an average DBT of 78minutes. In the 6 months post PAPA 18 of 33 STEMIs occurred ‘in hours’ with a DBT of 65 minutes. For in hour presentations there was an average 13 minute reduction of DBT after the re-installation of the second catheter laboratory-an improvement of 18% (p<0.05). Conclusion: Implementation of Pre-hospital Ambulance activation of Primary Angioplasty significantly decreased door to balloon time for primary coronary angioplasty in ST Elevation Myocardial Infarctions. The availability of a second catheterization laboratory ‘in hours’ added to improved door to balloon times. Disclosure of Interest: None Declared