Balloon Time In Patients Research Articles

Door to balloon time in patients presenting with acute ST elevation myocardial infarction and time factors influencing it; an observational study from a tertiary care teaching hospital in India

The objective of this prospective observational study was to assess the door-to-balloon time (D2B), in acute ST-segment elevation myocardial infarction (STEMI) patients and the time factors influencing it. The following timeframes were measured during the study: ED to ECG time, ED to coronary care unit time (ED2CCU), consent time, post-consent to balloon time (POSTCONSENT2B) and D2B. Effective D2B was 54 ± 12.2 min. Of the dependent variables, D2B had a strong positive correlation (ρ = 0.903) with consent time. This study sheds light on consent time a previously unrecognized entity as a significantly influencing factor for the D2B time.

Abstract 15151: The Prevalence of Covid-19 on the Door to Balloon Time in Patients With St-elevation Myocardial Infarction

Background: Patients with ST-elevation myocardial infarction (STEMI) should undergo primary PCI (percutaneous coronary intervention) as a standard of care. However, with the increase in the prevalence of COVID-19, all patients with suspected STEMI should be treated as possible COVID-19 cases. Therefore, more time may be needed to establish an acute MI diagnosis and to perform a COVID-19 status assessment. There has been a paucity of data regarding its influence on the primary PCI procedure. Objective: We sought to evaluate the impact of the prevalence of COVID-19 on the door-to-balloon time and clinical outcome in patient with STEMI. Method: Between January 2019 and May 2020, 157 patients with STEMI underwent primary PCI in 3 Japanese PCI centers. Mean age of patients was 70.4±12.9 years, and 71.6% were male. Right distal radial artery access was used in 110 patients (94.8%). We divided these patients into two groups: a group before the COVID -19 outbreak and another group during the pandemic, and were retrospectively analyzed. The following patients’ baseline characteristics were obtained: door-to-balloon time, duration in the emergency department, finding of CT scan if conducted, peak CK, 30-day mortality rate. Results: We evaluated patients with STEMI who underwent PCI between January 2019 and January 2020 (before the pandemic) and between February 2020 and May 2020 (during the pandemic). The number of patients was 119 before pandemic and 37 during pandemic. Mean door-to-balloon time was 35.8 ± 24.5 min before the pandemic and 41.2 ± 20.8 min after the outbreak (p<0.05). Induration at the emergency department was 22.6 ± 18.6 min before the pandemic and 21.3 ± 13.3 min after the outbreak (p=0.329). CT evaluation was performed before PCI was conducted in 41 patients (34.5%) and 14 patients (37.8%) (p=0.699). The peak CPK was 1956.2 ±2141.9 U/L and 2801.1 ± 2982.5 U/L (P=0.006). There was no significant difference in a 30-day mortality rate (5% vs 0%; P=0.699). Of the 37 patients after the outbreak, no patient underwent PCR examination for COVID-19 virus. Conclusion: The COVID-19 pandemic changed the diagnostic procedure in the emergency department and affected door-to-balloon time in patients with STEMI.

Modifiable factors associated with prolonged door to balloon time in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

Door to balloon (D2B) time was reported an important factor of the clinical outcome of patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). D2B time is influenced by various factors; however, modifiable factors have not been adequately evaluated. The purpose of this study was to identify modifiable factors associated with prolonged D2B time. We historically included 239 consecutive STEMI patients who visited emergency department and underwent primary PCI between April 2013 and September 2016. We evaluated baseline characteristics, mode and timing of hospital arrival, symptoms and signs, treatment times and angiographic characteristics. Patients with D2B time > 90min were compared with those with D2B time ≤ 90min. Modifiable factors associated with prolonged D2B time (> 90min) were analyzed by multivariable logistic regression model. The median D2B time for the entire cohort was 69min (interquartile range 54-89) and 24% had a D2B time of > 90min. Modifiable factors associated with prolonged treatment time (D2B time > 90min) were electrocardiogram (ECG) to puncture time > 50min [odds ratios (OR) 96.0, 95% confidence intervals (95% CI) 25.1-652.5, P < 0.0001), door to ECG time > 10min (OR 49.8, 95% CI 11.8-357.5, P < 0.0001), and puncture to balloon time > 30min (OR 48.5, 95% CI 12.0-333.8, P < 0.0001). ECG to puncture time > 50min was the most important modifiable factor associated with prolonged D2B time in STEMI patients.

Abstract 074: Door to Balloon Time in Patients With ST Elevation Myocardial Infarction With and Without Cardiopulmonary Arrest: is Exclusion From Public Reporting Justified?

Background: Since 2006 the Center for Medicare and Medicaid Services has allowed hospitals to exclude public reporting of door to balloon (D2B) time data for STEMI patients with cardiopulmonary arrest (CPA) within 90 minutes after hospital arrival, a high risk group with 30% in-hospital mortality. In July 2014, we implemented a high reliability STEMI process with rapid reperfusion goals for all STEMI patients treated with primary PCI at our center with no patient exclusions (figure). We studied D2B times for patients with and without in-hospital CPA before and after implementation of our high reliability STEMI process to clarify whether exclusion from public reporting on the basis of CPA is justified. Methods: We compared consecutive cases of STEMI treated with primary PCI at our center before (January 2013 to July 15 th , 2014) and after (July 16 th , 2014 to October 2016) implementation of a high reliability STEMI process, and we assessed D2B times in patients with and without in-hospital CPA prior to primary PCI. The primary endpoint was the % of patients treated within guideline D2B times ( &lt; 90 minutes for ED presenting patients or &lt; 120 minutes for inter-hospital transfer patients). Results: Over the study period 795 cases of STEMI were treated with primary PCI at our center. The control group constituted 37.4% (297/795) of patients who were treated prior to July 15 th , 2014, and the high reliability group constituted 62.6% (498/795) of patients treated after July 15 th , 2014. Patients presenting to our primary ED were 27.3% (217/795), inter-hospital transfer patients were 69.1% (549/795), and in-hospital STEMI patients were 3.6% (29/795). CPA within 90 minutes of hospital arrival occurred in 6.3% (50/795) of patients overall, and CPA was more prevalent in the control group vs the high reliability group (8.8% [26/297] vs 4.8% [24/498], P=0.027). In the control group patients with CPA were less likely to achieve goal D2B times compared to patients without CPA (30.8% [8/26] vs 60.5% [164/271], P=0.003), whereas in the high reliability group there was no difference in the rate of achievement of goal D2B times in patients with vs without CPA (75.0% [18/24] vs 81.6% [387/474], P=0.418). Conclusion: High reliability STEMI processes can improve delivery of care for the most vulnerable and highest risk patients.

Using a Cloud Computing System to Reduce Door-to-Balloon Time in Acute ST-Elevation Myocardial Infarction Patients Transferred for Percutaneous Coronary Intervention.

Background This study evaluated the impact on clinical outcomes using a cloud computing system to reduce percutaneous coronary intervention hospital door-to-balloon (DTB) time for ST segment elevation myocardial infarction (STEMI). Methods A total of 369 patients before and after implementation of the transfer protocol were enrolled. Of these patients, 262 were transferred through protocol while the other 107 patients were transferred through the traditional referral process. Results There were no significant differences in DTB time, pain to door of STEMI receiving center arrival time, and pain to balloon time between the two groups. Pain to electrocardiography time in patients with Killip I/II and catheterization laboratory to balloon time in patients with Killip III/IV were significantly reduced in transferred through protocol group compared to in traditional referral process group (both p < 0.05). There were also no remarkable differences in the complication rate and 30-day mortality between two groups. The multivariate analysis revealed that the independent predictors of 30-day mortality were elderly patients, advanced Killip score, and higher level of troponin-I. Conclusions This study showed that patients transferred through our present protocol could reduce pain to electrocardiography and catheterization laboratory to balloon time in Killip I/II and III/IV patients separately. However, this study showed that using a cloud computing system in our present protocol did not reduce DTB time.

Management and outcome of patients with acute myocardial infarction presenting with pacemaker rhythm

BackgroundDiagnosis of acute myocardial infarction (MI) is challenging in pacemaker patients. Little is known about this patient group. MethodsPatients with MI enrolled in the Swiss national AMIS Plus registry between January 2005 and December 2015 were analyzed. All patients with either paced ventricular rhythm or sinus rhythm with intrinsic ventricular conduction (IVC) were included in this study. Outcomes using crude data and propensity score matching were compared between patients with pacemaker rhythm and patients with IVC. The primary endpoint was in-hospital death. ResultsData from 300 patients with paced rhythm and 27,595 with IVC were analyzed. Patients with pacemaker rhythm were older (78.2y vs 65.4y; p<0.001), had more comorbidities (Charlson Index (CCI)>1: 54.0% vs 21.1%; p<0.001) and a higher rate of heart failure upon presentation (Killip class>2, 11.0% vs 5.9%; p<0.001) compared to patients with IVC. Door to balloon time in patients undergoing acute PCI is markedly delayed in contrast to patients with IVC (280min vs 85min; p<0.001). Consequently, crude mortality in patients with pacemakers was high (11.3% vs 4.6%; p<0.001). However, when analyzed with propensity matching for gender, age, CCI>1 and Killip>2, mortality was similar (11.2% vs 10.5%; p=0.70). ConclusionPacemaker patients with acute MI represent a high-risk group with doubled crude mortality compared to patients without pacemakers, due to higher age and higher Killip class. Diagnosis is difficult and results in delayed treatment.Treatment algorithms for MI with paced rhythm should possibly be adapted to those used for STEMI or new left bundle branch block.Clinical Trials Registration: NCT01305785.

Strategies for reducing door to balloon time in patients with acute myocardial infarction undergoing primary angioplasty: the Pavia experience

Primary percutaneous coronary intervention (pPCI) is the treatment of choice in patients with ST-elevation myocardial infarction (STEMI) if performed by an experienced team within 120 min of first medical contact. The door to balloon time (DTB) has become a performance measure and is the focus of local, regional and national quality improvement initiatives. The primary objective of the present study was to evaluate whether the implementation of reperfusion strategies could result in shorter DTB times. In 2007, at the cath lab of the IRCCS Policlinico San Matteo (a hub of a network including 7 spoke centers), 245 pPCI were performed with a median DTB time of 116 (25th-75th percentile, 96-155) min, and <90 min only in 20% of cases. To improve time to reperfusion, the following strategies were adopted in 2010 and 2011: direct access to the cath lab without initial coronary care unit admission; activation of the cath lab based on pre-hospital ECG; a faster triage with ECG performed within 10 min and use of a dedicated ambulance for patients presenting directly to the emergency room (ER) of the hub. Overall, 226 and 258 pPCI were performed in 2010 and 2011, respectively, with no differences in type of hospital admission (emergency medical service, ER, or spoke) compared with 2007. A significant DTB reduction was observed (2007 vs 2010 vs 2011: 116 [96-155] vs 99 [77-129] vs 97 [80-125] min, p<0.0001), with a significant improvement in the number of patients treated within 90 min (20 vs 41 vs 40%, p<0.0001) as a result of a significant reduction in the time from first medical contact to cath lab (86 [64-124] vs 66 [50-93] vs 62 [46-93] min, p<0.0001). By analyzing only data from 2010 and 2011, median DTB was 88 (73-104) min for patients arriving through the emergency medical service, 139 (116-179) min for patients presenting to spoke centers, and 96 (75-126) min for patients presenting to the ER, with pPCI performed within 90 min in 55%, 8% e 42% of cases, respectively. The longer DTB time of the spoke centers was solely due to transportation to the hub (emergency medical service vs spoke: 56 [42-68] vs 106 [86-147] min, p<0.0001), with no differences in time to reperfusion once the cath lab was reached. Based on our strategies and experience including 729 STEMI patients treated with pPCI in 2007, 2010 and 2011, a significant improvement in DTB time was achieved. The main factor affecting our results is transportation to the cath lab for patients with direct access to spoke centers. Further exploration and advocacy for DTB implementation in these patients are warranted.

Study on the Impacts of remote real-time transmission 12-lead electrocardiogram system on door-to- balloon time in patients with ST-segment elevation myocardial infarction

Objective This study was aimed to evaluate the remote real-time transmission 12-lead electrocardiogram system on door-to-balloon time in patients with ST-segment elevation myocardial infarction. Methods We retrospectively analyzed the consecutive patients with STEM I who had accepted primary percutaneous coronary intervention (PCI) in the chest pain center of our hospital from February 2012 to July 2012. The study group consisted of patients with pre-hospital ECG, while the control group included patients without pre-hospital ECG, Their door-to-balloon time and door-to-catheter room time, mortality w ere compared. Results Totally 60 consecutive patients who had received primary PC I for STEMI were evaluated. Among them, 35 patients were hospitalized with pre-hospital ECG while the other 25 patients without ECG. The Pre-hospital ECG was associated with a significantly shorter median door-to-balloon time (38 min vs. 94min; P 0.05), Significant difference was seen in the median hospital time in study group (5 compared with control group (7day) (5 day vs. 7 day ; P <0.01). Conclusions The remote real-time transmission 12-lead electrocardiogram system is associated with a significantly shorter door-to- balloon time in STEMI patients. The remote real-time transmission 12-lead electrocardiogram system is recommended in patients suspected STEMI. Key words: Acute ST-segment elevation myocardial infarction; Pre-hospital electrocardiogram; Door-to-balloon time; Electrocardiogram/remote-electrocardiogram; Real-time; Tele-medicine; Remote ECG monitoring; Wireless/3G; Pre-hospital diagnosis

Abstract 15193: The Impact of Age and Gender on Door to Balloon Time in Patients with ST Elevation Myocardial Infarction

Introduction: Shortening door-to-balloon (D2B) time is important to improve outcomes in patients suffering ST elevated acute myocardial infarction (STEMI). Age and gender are associated with poor outcomes in previous reports, however the impact of differences in age and gender on D2B time is still unclear. Objective: To determine the association of age and gender with D2B time in patients suffering STEMI. Methods: The Yokohama cardiovascular workshop registry is a prospective multicenter cohort in an urban area of Japan. 1261 consecutive STEMI patients during May 2010 to May 2013 were enrolled for the present analysis. Patients were divided into four groups according to age (&gt;75years old) and gender; elderly female (n=146), young female (n=125), elderly male (n=206) and young male (n=783). Results: D2B time was longer in female gender (93.2 vs. 85.5 min, p&lt;0.01) and in the elderly (92.3 vs. 85.1, p&lt;0.001). Among the four groups described above, D2B time was the longest in elderly female patients and followed by young female patients (p=0.002). Elderly female patients also had the lowest proportion of Killip class I, the longest time interval from hospital arrival to achieve TIMI flow grade 2/3, the worst final TIMI flow grade and the highest in-hospital mortality. The percentage of patients in achieving D2B time &lt;90min was the lowest in elderly male (p&lt;0.001, odds ratio 0.54) followed by elderly female (p=0.009, odds ratio 0.61). Conclusions: Both female gender and higher age were associated with longer D2B time in patients with STEMI. Further effort should be made to shorten the D2B time, especially in the elderly and women, for the improvement of clinical outcomes.

Operator's procedure volume and not years of experience, determine needle to balloon time in primary percutaneous coronary intervention

This study aimed at evaluating operator and procedural variables affecting needle to balloon time in primary percutaneous coronary intervention. The relationship between operator's variables with needle to balloon time is unknown. A total of 399 consecutive patients from 06/2010 to 03/2012 presenting with ST-elevation myocardial infarction in a community medical center were included in the study. Operator experience was calculated in number of years in interventional practice and operator procedure volume in number of percutaneous coronary intervention procedures performed annually. The time of arrival was divided into regular hours (7 am to 4 pm) and off hours (4 pm to 7 am) on weekdays and the entire duration on weekends and holidays. The average patient age was 65 years and 59% were males. The mean needle to balloon time was 18.53 ± 8 min. There was no difference in needle to balloon time between patients presenting during regular hours compared to those presenting during off hours (18.19 ± 6.88 vs. 18.93 ± 9.13, P > 0.5). Operator experience (coefficient = -0.10, P = 0.03) and procedure volume (coefficient = -0.63, P < 0.0001) showed negative correlation with needle to balloon time. In multivariate analysis after adjusting for access sites and operator experience, procedure volume was the only independent predictor of needle to balloon time (P < 0.001). Operator procedure volume and not the years of experience, determine the needle to balloon time in patients undergoing primary percutaneous coronary intervention. Operator performance as assessed by needle to balloon time is not affected by the time of the day.

TCT-428 Radial access does not affect door to balloon time in patients undergoing primary PCI

TCT-428 Radial access does not affect door to balloon time in patients undergoing primary PCI

The Impact of Gender on Door to Balloon Time of Patients with ST Elevation Myocardial Infarction

The Impact of Gender on Door to Balloon Time of Patients with ST Elevation Myocardial Infarction

Symptom onset to balloon time in patients with ST-segment elevation myocardial infarction treated by primary coronary angioplasty: influence on ST-segment resolution and on mortality

With controversy in the field, we wanted to assess the influence of symptom onset to balloon time in ST-segment elevation myocardial infarction (STEMI) treated by primary coronary angioplasty (PCA), on ST-segment resolution and on the 1-year mortality.