Simultaneous computerised activation of the primary percutaneous coronary intervention pathway reduces out-of-hours door-to-balloon time but not mortality

Abstract

BackgroundIn 2009 activation of out of hours (OOH) primary percutaneous coronary intervention (PPCI) in our institution changed from separate telephone calls to a simultaneous computerised alert. We assessed the impact of this protocol change on door-to-balloon (DTB) time, in hospital and 1year mortality. MethodsRetrospective survey of our Myocardial Ischaemia National Audit Project (MINAP) database. OOH patients were categorised — pre- (Group 1) and post- (Group 2) introduction of the computerised alert protocol. ResultsOOH PPCI was performed for 793 patients (mean age 61, 73.4% male) — 295 in Group 1 and 498 in Group 2. Median DTB times were 92min (interquartile range [IQR] 75–111) for Group 1 and 76min (IQR 64–97) for Group 2 (p<0.0001). Forty-eight percent achieved DTB in ≤90min in Group 1 compared to 70% in Group 2 (p<0.0001). Computerised alert was associated with a shorter DTB time on multivariate analysis (beta coefficient −0.09, p=0.03 for linear regression and OR 2.8, 95% CI 1.6–5.0, p<0.0001 for logistic regression). In hospital mortality was 4.1% in Group 1 and 5% in Group 2 (p=0.60). All-cause mortality at 1year was 6.1% in Group 1 and 9.9% in Group 2 (p=0.09). ConclusionsSimultaneous computerised activation for OOH PPCI reduced DTB times, increased the number of patients achieving target DTB times but did not affect mortality.