Time to ECG diagnosis delays inter-hospital transfer to revascularization in STEMI patients presenting to a regional emergency department: a five-year audit.

Abstract

Reducing the door-to-balloon time (D2BT) in ST-elevation myocardial infarction (STEMI) patients maximizes myocardial salvage and mitigates morbidity/mortality. To assess the D2BT in STEMI patients requiring inter-hospital transfer for revascularization and identify any potential causes of delay. Consecutive patients presenting to the Connolly Hospital Blanchardstown (CHB) emergency department (ED) who were transferred to the Mater Misericordiae University Hospital in Dublin for primary percutaneous coronary intervention from January 2018 to October 2022 were identified in a regional database and their D2BTs calculated. D2BTs were further sub-categorized into key intervals to identify any potential causes of delay. A total of 90 patients were included for analysis, with a median D2BT of 117.5min (interquartile range [IQR]: 99.3-170.8min) and 52.5% of patients achieving the ≤ 120min target. Despite being the shortest interval considered, the time from arrival at the CHB ED to diagnostic electrocardiogram (ECG) was a substantial contributor to the overall delay to revascularization given its wide variability (median: 18.0min; IQR: 9.0-46.8min), with only 28.8% of patients achieving the ≤ 10min target. Nearly half of the patients studied failed to achieve the overall target D2BT for revascularization. The time from arrival at the CHB ED to diagnostic ECG was identified as a substantial contributor to this failure, with a median time almost twice that of the target and a quarter of all patients spending longer than 46.8min. These findings highlight a need to improve the implementation of ECG triage and interpretation in the ED.