Balloon Time Research Articles

Effect of limitation in flow of people on medical care quality in emergency resuscitation room

Objective To investigate the effect of limitation in flow of people on medical care quality in emergency resuscitation room (ERR). Methods This study was retrospectively performed to compare emergency medical quality before and after (October to December, 2015 vs. February to April, 2016) limitation of flow of people in ERR. Variables included noise level, occupational exposure, adverse event, hospital-acquired infection, length of stay (LOS) in ERR, mortality rate, return of spontaneous circulation (ROSC) rate after cardiopulmonary resuscitation (CPR), the rate of unexpected return to ERR, door to drug and door to balloon time for patients with ST-segment elevated myocardial infarction (STEMI), patients' and emergency personnels' satisfaction level. The data were analyzed with t-test, chi-square test or Poisson Z test where appropriate. Results There were 5 031 and 5 097 patients respectively admitted in ERR before and after limitation of flow of people. Patients' main diagnoses and severity of illness between the two periods had no significantly difference (P>0.05). After the limitation of flow of people, the noise level in ERR was lowered (P<0.01), the numbers of occupational exposure events (14 cases vs. 4 cases, Z=2.357, P=0.018) and adverse events (18 cases vs. 5 cases, Z=2.711, P=0.007) were decreased, the rate of hospital-acquired infection was reduced (1.1% vs. 0.5%, χ2=8.111, P=0.004), the LOS in ERR was shortened [(6.3±0.8) h vs. (4.6±0.6) h, t=121.083, P<0.01], the door to balloon time for STEMI patients was also decreased [(91.2±12.8) min vs. (89.3±8.0) min, t=2.486, P=0.013]. Moreover, patients’ and emergency personnels’ satisfaction level were elevated. No significant difference was observed in mortality rate, ROSC rate, rate of unexpected return to ERR and door to drug time for STEMI patients. Conclusions The limitation of flow of people in ERR can lower the noise level, reduce emergency personnels’ working pressure, improve their working efficiency, avoid medical errors, elevate patients’ and emergency personnels’ satisfaction level. Key words: Emergency resuscitation room; Flow of people; Medical care quality; Hospital-acquired infection; Mortality rate; Green channel; Satisfaction level

From Cardiologist to Patient….

I had a partial seizure while riding my bicycle on a trainer one morning. It was 6:10 am. Like an aortic dissection, the time and place of a seizure is easy to remember to the minute. At the time, I was not sure what happened and surprisingly not scared. I felt the need to talk, but could not spit out any words. My wife was exercising at a local gym, and I was by myself in the basement. And before I could get too worried, I was completely fine. Just like that. I didn’t know what happened so I got on the treadmill, ran a mile, and figured all things were a go. I went off to work and, in an offhand remark, told my wife of the incident. With my last patient of the day, however, it happened again. This time there was no denying something was wrong. Although I couldn’t speak, I was able to write so I scribbled to my patient that I could not talk on the back of an EKG. He promptly got my nurse practitioner and my partner. They gave me an aspirin because, well, we are cardiologists. The working diagnosis was a transient ischemic attack, and they performed an EKG right away. (Again, you use the tools available to you.) My symptoms resolved shortly but this time I was going to the hospital. In the emergency department, I was a celebrity. Several cardiologists and nurses were waiting for me as soon as I arrived. In fact, I had an immediate cardiology consult from one of the interventionalists. If this were a STEMI. I was going to have a door to balloon time of 10 minutes. But instead my first test turned out to be a noncontrast head computed tomography. This ruled out …

Significado clínico de los cambios recíprocos del segmento ST en pacientes con IAMCEST: estudio de imagen con resonancia magnética cardiaca

Introduction and objectivesWe sought to determine the association of reciprocal change in the ST-segment with myocardial injury assessed by cardiac magnetic resonance (CMR) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). MethodsWe performed CMR imaging in 244 patients who underwent primary PCI for their first STEMI; CMR was performed a median 3 days after primary PCI. The first electrocardiogram was analyzed, and patients were stratified according to the presence of reciprocal change. The primary outcome was infarct size measured by CMR. Secondary outcomes were area at risk and myocardial salvage index. ResultsPatients with reciprocal change (n=133, 54.5%) had a lower incidence of anterior infarction (27.8% vs 71.2%, P < .001) and shorter symptom onset to balloon time (221.5±169.8 vs 289.7±337.3min, P=.042). Using a multiple linear regression model, we found that patients with reciprocal change had a larger area at risk (P=.002) and a greater myocardial salvage index (P=.04) than patients without reciprocal change. Consequently, myocardial infarct size was not significantly different between the 2 groups (P=.14). The rate of major adverse cardiovascular events, including all-cause death, myocardial infarction, and repeat coronary revascularization, was similar between the 2 groups after 2 years of follow-up (P=.92). ConclusionsReciprocal ST-segment change was associated with larger extent of ischemic myocardium at risk and more myocardial salvage but not with final infarct size or adverse clinical outcomes in STEMI patients undergoing primary PCI.Full English text available from: www.revespcardiol.org/en

Emergency management of patients with ST-segment elevation myocardial infarction in Eastern Austria: a descriptive quality control study

BackgroundMyocardial infarction is a time-critical condition and its outcome is determined by appropriate emergency care. Thus we assessed the efficacy of a supra-regional ST-segment elevation myocardial infarction (STEMI) network in Easternern Austria.MethodsThe Eastern Austrian STEMI network serves a population of approx. 766.000 inhabitants within a region of 4186 km2. Established in 2007, it now comprises 20 pre-hospital emergency medical service (EMS) units (10 of these physician-staffed), 4 hospitals and 3 cardiac intervention centres. Treatment guidelines were updated in 2012 and documentation within a web-based STEMI registry became mandatory. For this retrospective qualitative control study, data from February 2012–April 2015 was assessed.ResultsA total of 416 STEMI cases were documented, and 99% were identified by EMS within 6 (4.0–8.0) minutes after arrival. Median time loss between onset of pain and EMS call was 54 (20–135) minutes; response, pre-hospital and door-to-balloon times were 14 (10–20), 46 (37–59) and 45 (32–66) minutes, respectively. When general practitioners were involved, time between onset of pain and balloon inflation significantly increased from 180 (135–254) to 218 (155–348) minutes (p < .001). A pre-hospital time < 30 min was achieved in 25.8% of all patients during the day vs. 11.6% during the night (p < .001). Three hundred forty-five patients (83%) were subjected to primary percutaneous coronary intervention (PPCI), and 6.5% were thrombolysed by EMS. Pre-hospital complication rate was 18% (witnessed cardiac arrest 7%, threatening arrhythmias 6%, cardiogenic shock 5%). Twenty-four hours and hospital mortality rate were 1.2 and 2.8%, respectively.DiscussionOptimal patient care and subsequently outcome of STEMI is strongly determined by a short patient-decision time to call EMS and by the first medical contact to balloon time (FMCBT). Supra-regional networks are key in order to increase the efficacy and efficiency of health care. The goal of 120 min FMCBT was achieved in 78% of our patients immediately managed by EMS, thus indicating room for improvement.ConclusionIn conclusion, results from the Eastern Austrian STEMI network shed light on the necessity of increasing patient awareness in order to minimize any time loss derived by delayed EMS calls. Involvement of family physicians resulted in prolonged FMCBT. A stronger utilization of rescue helicopters could further improve the efficacy of this supra-regional network. Nevertheless PPCI rates, time intervals and outcome rates compare well with international benchmarks.

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.

Determinants of total ischemic time in primary percutaneous coronary interventions: A prospective analysis

ObjectiveTo assess the factors contributing to longer total ischemic times in ST elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI). MethodsThree hundred forty-six patients who underwent PPCI from July 2016 to June 2017 were studied. From time for the patient to recognize the symptoms, time was divided into 11 stages, any reason for delay was observed. ResultsMean window period was 6.7 ± 9.8 hours. Mean time to recognize the symptoms, reach first medical contact and prehospital management were 150.2 ± 140.5 min, 58.5 ± 57.0 min and 36.3 ± 38.0 min, respectively. Mean time for the patients brought in ambulance was 82.4 ± 59.8 min whereas for those transported in other vehicles was 130.4 ± 59.7 min (p = < 0.0001). Mean door to electrocardiogram (ECG) time, decision for PPCI, consent time and STEMI team activation time were 6.2 ± 3.1 min, 8.3 ± 4.5 min, 12.6 ± 16.2 min and 10.7 ± 8.2 min, respectively. Mean time for financial process and mean sheath to balloon time were 9.1 ± 6.9 min and 21.8 ± 11.7 min, respectively. Door to balloon time (DTB) was <90 min in 81% of the patients, mean DTB was 72.0 ± 33.0 min. Mean DTB for cases performed during night was 72.6 ± 32.9 min, whereas for those performed during day was 60.3 ± 30.2 min (p < 0.05). Total 30 day mortality was 2.9%. Mortality among DTB <90 min was 1.4%, mortality among DTB > 90 min was 9% (p < 0.05). ConclusionsThe main contributor for longer total ischemic time was the time taken for the patient to recognize the symptoms. DTB of <90 min can be achieved with effective hospital strategies.

Abstract 116: Independent Prognostic Value of Guideline-Directed Medical Therapy, Radial Access, and Door-to-Balloon Time in Predicting STEMI In-Hospital Mortality

Background: Systems-based strategies to improve STEMI care have traditionally focused on improving door to balloon time (D2BT) performance. However, prompt guideline-directed medical therapy (GDMT) and use of radial access for PCI are also associated with reduced mortality in patients with STEMI. The incremental value of each facet of STEMI care on mortality is unknown. Methods: On 7/15/14 we implemented a comprehensive four-step STEMI protocol at our institution: (1) ED physician cath lab activation (2) Safe STEMI Handoff Checklist with GDMT decision support (3) immediate transfer to an immediately available cath lab and (4) radial access for PCI. The protocol was intended to minimize care variability in GDMT (aspirin, P2Y12 inhibitor, and anticoagulant) prior to PCI, use of radial access for PCI, and D2BT. We studied consecutive patients with STEMI treated with PCI at our center (1/1/11-12/31/16) to assess the incremental prognostic value of these STEMI care processes using logistic regression models. Results: Of 1272 participants mean age was 61+/-12 years and 68% were men. STEMI presenting location was 25% primary ED, 69% inter-hospital transfer, and 6% in-hospital. The rates of GDMT prior to PCI (74% vs 83%, P&lt;0.001) and radial access for PCI (19% vs. 67%, P&lt;0.001) improved and median D2BT (106 [81-140] vs. 90 [68-109], P&lt;0.001) decreased after implementation of the comprehensive four-step STEMI protocol. In a multivariable model, GDMT prior to PCI (OR 0.42, 95% CI 0.25-0.71, P=0.001), radial access for PCI (OR 0.44, 95% CI 0.23-0.82, P=0.002), and decreasing D2BT (10min decrease: OR 0.96, 95% CI 0.94-0.99, P=0.007) were each independently associated with reduced odds of in-hospital mortality. Step-wise modeling of the risk of in-hospital mortality demonstrated that GDMT prior to PCI, radial access for PCI, and D2BT performance provided incremental prognostic value when added in stepwise order of the occurrence of these care processes in clinical practice (Figure). Conclusions: Prompt GDMT administration, radial access for PCI, and D2BT performance add incremental prognostic value. Expanding STEMI systems of care from a singular focus on D2BT to a comprehensive focus on multi-faceted STEMI care offers an opportunity to further improve STEMI outcomes.

Comparison of epidemiology, treatments and outcomes of ST segment elevation myocardial infarction between young and elderly patients

BackgroundWith an ageing population, there is a need to understand the relative risk/benefit of interventions for elderly ST segment elevation myocardial infarction (STEMI) patients. The primary aim of this study...

The contribution of gender and age on early and late mortality following ST-segment elevation myocardial infarction: results from the Korean Acute Myocardial Infarction National Registry with Registries.

BackgroundAlthough previous studies using Korean data have already reported higher rates of mortality in women, it is less clear whether these gender differences in prognosis post ST-segment elevation myocardial infarction (STEMI), are age dependent. The aim of this study is to examine the gender-age interaction with early and late mortality in patients with STEMI enrolled in the Korean nationwide registry.MethodsThis prospective study stratified outcomes according to gender and age from 17,021 STEMI patients. We compared in-hospital, early (30 days) and late (12 months) mortality between gender to examine the gender-age interaction in multivariable models.ResultsIn younger women (< 60 years), in-hospital [5.8% vs. 2.5%, P < 0.001; unadjusted odds ratios (OR): 2.41, 95% confidence intervals (CI): 1.59–3.66], early (6.2% vs. 2.6%, P < 0.001; unadjusted OR: 2.4, 95% CI: 2.12–2.72) and late mortality (7.0% vs. 3.1%, P > 0.001; unadjusted OR: 2.33, 95% CI: 2.08–2.61) were significantly higher compared with men. However, after adjustment for patient characteristics, Killip class ≥ 3, symptom to balloon time and major bleeding, and in-hospital bleeding, overall early and late mortality were no longer related to gender in any age groups.ConclusionsAmong a Korean population with STEMI, higher early and late mortality in younger women may be explained by poor patient characteristics, higher Killip class ≥ 3, longer symptom to balloon time and more frequent major bleeding. Therefore, based on gender-age differences, more precise and aggressive preventive strategies focused on risk factor reduction, education and more intensive management for younger women should be performed.

IMPACT OF THE CMS ALGORITHM FOR DOOR-TO-BALLOON TIME PUBLIC REPORTING ON DOOR-TO-BALLOON TIME PERFORMANCE

CMS publically reported door to balloon times (D2BT) for each primary percutaneous coronary intervention (PPCI) center in the US over the past decade. The impact of patient exclusions on reported D2BT performance is unknown. We reviewed all cases of STEMI treated with PPCI at our center (1/1/11 to

GENDER DIFFERENCES IN STEMI OUTCOMES BEFORE AND AFTER IMPLEMENTATION OF A COMPREHENSIVE FOUR-STEP PROGRAM TO IMPROVE STEMI CARE

Women with STEMI have longer door to balloon times (D2BT) and higher mortality compared to men. Strategies to reduce gender disparities in STEMI care are needed. On 7/15/14 we implemented a comprehensive 4-step STEMI program (CSP) including (1) ED cath lab activation criteria (2) checklist for

Does preserved sphincter of Oddi function prevent common bile duct stones recurrence in patients after endoscopic papillary balloon dilation?

BackgroundWhether preserving sphincter of Oddi (SO) function by endoscopic papillary balloon dilation (EPBD) is beneficial for preventing recurrent common bile duct stone disease (CBDS) is controversial. The aim of this study was to measure sphincter of Oddi (SO) function by using SO manometry, and to evaluate the association with recurrent CBDS. MethodsPatients with suspected CBDS who underwent successful EPBD were included. These patients underwent SO manometry at two months after EPBD with bile duct clearance. They were regularly followed for recurrent CBDS. ResultsFrom January 2000 to December 2009, 185 patients received EPBD and SO manometry was included. There were 64% male with mean age of 65 ± 15.6 years. Mean ballooning inflation size was 1.1 ± 0.19 cm and mean ballooning time was 4.5 ± 0.85 min 55.7% had a sphincter of Oddi basal pressure (SOBP) of 0 mmHg, 16.2% < 10 mmHg, 26.5% 10–40 mmHg, and 1.6% > 40 mmHg. In multivariate analysis, EPBD with balloon ≥1.2 cm was the only factor for loss of SO function. Moreover, patients with preserved SO function had higher stone recurrence rate (15% vs. 5%, p = 0.034). ConclusionEPBD using balloon ≥1.2 cm is a major factor for loss of SO function, which seems to reduce the risk of recurrent CBD stones.

Clinical Significance of Reciprocal ST-segment Changes in Patients With STEMI: A Cardiac Magnetic Resonance Imaging Study

Introduction and objectivesWe sought to determine the association of reciprocal change in the ST-segment with myocardial injury assessed by cardiac magnetic resonance (CMR) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). MethodsWe performed CMR imaging in 244 patients who underwent primary PCI for their first STEMI; CMR was performed a median 3 days after primary PCI. The first electrocardiogram was analyzed, and patients were stratified according to the presence of reciprocal change. The primary outcome was infarct size measured by CMR. Secondary outcomes were area at risk and myocardial salvage index. ResultsPatients with reciprocal change (n=133, 54.5%) had a lower incidence of anterior infarction (27.8% vs 71.2%, P < .001) and shorter symptom onset to balloon time (221.5±169.8 vs 289.7±337.3min, P=.042). Using a multiple linear regression model, we found that patients with reciprocal change had a larger area at risk (P=.002) and a greater myocardial salvage index (P=.04) than patients without reciprocal change. Consequently, myocardial infarct size was not significantly different between the 2 groups (P=.14). The rate of major adverse cardiovascular events, including all-cause death, myocardial infarction, and repeat coronary revascularization, was similar between the 2 groups after 2 years of follow-up (P=.92). ConclusionsReciprocal ST-segment change was associated with larger extent of ischemic myocardium at risk and more myocardial salvage but not with final infarct size or adverse clinical outcomes in STEMI patients undergoing primary PCI.

Healthcare-based on Cloud Electrocardiogram System: A Medical Center Experience in Middle Taiwan.

Electrocardiogram (ECG) as one of the best methods to measure irregular heartbeats is a dispensable method for doctor to diagnose Acute Myocardial Infarction (AMI) patients. Most medical centers in Taiwan implement the reduction of Door to Balloon (D2B) time, which is defined as the time interval starting when an Acute-Myocardial-Infarction patient arrives at the Emergency Department, and ending when a catheter guide wire crosses the culprit lesion as the acute-myocardial-infarction treatment on the patient in the cardiac catheterization room. Generally, when a patient with acute-chest pain is sent into a hospital (always to Emergency Department), the hospital will collect his/her ECG which needs to be evaluated by a cardiologist to ensure that the patient really has Acute Myocardial Infarction. Then the medical workers deliver the patient to the cardiac catheterization room to operate balloon angioplasty. In previous years, the cardiologist must utilize a PC to connect to the Intranet of the hospital and employ a special PACS (Picture Archiving and Communication System) image browser before he/she can check the patient's ECG. But this will prolong the D2B time since the doctor may stay outdoors and he/she needs some time to find a PC and network. Of course, if the PC has not installed the PACS image browser, the doctor has to download and install it. Consequently, the D2B time should be worsened, thus possibly impacting the patient's life. Therefore, in this paper, we introduce a Cloud-based Electrocardiogram System, with which cardiologists can directly utilize their smart phones to browse the patient's ECG so as to shorten the D2B time. This system has been online in a medical center in middle Taiwan for more than one year. The shortened D2B time is longer than 10min, i.e., receiving fine results.

Outcome of Change in Location and Protocol on First Medical Contact to Balloon Time

Background: In patients with ST-elevation myocardial infarction (STEMI) there is a 90-minute target between first medical contact and balloon time. In 2017, the Sunshine Coast Hospital and Health Service moved their service location from Nambour General Hospital (NGH) to the new Sunshine Coast University Hospital (SCUH), a distance of 31 km. With the change in location there was also a change in local protocol, with the aim to improve STEMI meeting targets, which is something that the institution had previously been struggling to achieve.

A Regional Primary Reperfusion Pathway: Increased Use of Thrombolysis is Both Safe and Effective

Background: Coinciding with the change in service location from Nambour General Hospital (NGH) to the new facility at Sunshine Coast University Hospital (SCUH) there was refinement of the local ST-elevation myocardial infarction (STEMI) protocol reflecting the updated Cardiac Society of Australia and New Zealand 2016 Acute Coronary Syndrome Guidelines. These guidelines placed greater emphasis on achieving first medical contact (FMC) to balloon times of ≤90 minutes, with increased use of thrombolysis.

Keys to Achieving Target First Medical Contact to Balloon Times and Bypassing Emergency Department More Important Than Distance.

Background Australian guidelines advocate primary percutaneous coronary intervention (PPCI) as the reperfusion strategy of choice for ST elevation myocardial infarction (STEMI) in patients in whom it can be performed within 90 minutes of first medical contact; otherwise, fibrinolytic therapy is preferred. In a large health district, the reperfusion strategy is often chosen in the prehospital setting. We sought to identify a distance from a PCI centre, which made it unlikely first medical contact to balloon time (FMCTB) of less than 90 minutes could be achieved in the Hunter New England health district and to identify causes of delay in patients who were triaged to a PPCI strategy. Methods and Results We studied 116 patients presenting via the ambulance service with STEMI from January 2016 to December 2016. In patients who were taken directly to the cardiac catheterisation lab, a maximum distance of 50 km from hospital resulted in 75% of patients receiving PCI within 90 minutes and approximately 95% of patients receiving PCI within 120 minutes. Patients who bypassed the emergency department (ED) were significantly more likely to have FMCTB of less than 90 minutes (p < 0.001) despite having a longer travel distance (28.5 km versus 17.4 km, p < 0.001). Patients transiting via the ED were significantly more likely to present out of hours (60 versus 24.2% p < 0.001). Conclusions Patients who do not bypass the ED have a longer FMCTB across all spectrum of distances from the PCI centre; therefore, bypassing the ED is key to achieving target FMCTB times. Using a cutoff distance of 50 km may reduce human error in estimating travel time to our PCI centre and thereby identifying patients who should receive prehospital thrombolysis.

In hospital outcomes of primary percutaneous intervention in patients presenting with acute myocardial infarction in Saudi Arabia – A single center study

OBJECTIVE: To study the presentation, response to treatment, complication and prognosis of patients with acute ST-Elevation myocardial infarction (STEMI) who were treated with primary percutaneous coronary intervention (PPCI) at King Faisal Cardiac Center (KFCC) in the period from January 2015 till December 2016. METHODS: Data of 77 patients with STEMI who were treated with primary PCI as a mode of reperfusion who presented to KFCC were collected retrospectively from January 2015 till December 2016. The primary end point was in hospital mortality. RESULTS: 77 patients with STEMI received PPCI. These were predominantly male (86%, no=66). The mean age was 57.9 (SD ± 11.8). History of Diabetes was present in (64.7%, no=49), hypertension (49% no=38) dyslipidemia (51% no=39) and smoking (41.6%, no=32). Chest pain was the most common presenting symptoms (97%, no=75). Only 5 patients (6%) presented to emergency department within 1 hour from chest pain onset. While 7 (8%) of patients presented beyond 12 hours the majority of patients arrived within 6 hours 29 patients (38%) and 37 patients (48%) arrived after 6 hours but within 12 hours from pain onset. The median door to balloon time was 84 minutes (IQR: 63.5- 111.5 minutes). Door to balloon time of less than 90 minutes was achieved in (62%, no=46) while D2B time of more than 90 minutes but within 120 minutes was seen in (22 %,) while (16%) had D2B time of more than 120 minutes. The left anterior descending artery was the culprit in 37 patients (48%) Femoral artery access was used in 48 patients (62%).The success of delivering the stent was 97% (no =75). The Median length of hospital stay was 3 days (IQR: 2-4). The primary endpoint of inhospital death was 5.1%. CONCLUSION: Our findings suggest favorable outcomes of STEMI patients treated with PPCI, matching the international data. D2B time remains below acceptable standers. Regardless of logistic limitations Primary PCI should be the preferred method of reperfusion. Strategies towards increasing patient’s access and improving D2B time should be adopted.

Door to Balloon Time in Men Versus Women: Is the Gender Difference Closing?

Door to Balloon Time in Men Versus Women: Is the Gender Difference Closing?

Smartphone transmission of electrocardiography images to reduce time of cardiac catheterization laboratory activation

BackgroundThis retrospective study evaluated the use of a smartphone application to facilitate communication between the emergency physician (EP) and the interventional cardiologist in order to minimize the time to cardiac catheterization laboratory (CCL) activation and time to percutaneous coronary intervention (PCI). MethodsWe retrospectively collected pertinent time-points in the management of patients diagnosed with STEMI in the emergency department and their outcome. The primary outcome was the reduction in the time from ECG interpretation to CCL activation after the implementation of a smartphone application. A total of 84 patients were enrolled. Patients' electrocardiography (ECG) were described by traditional verbal communication via telephone (group 1, n = 40) and by additional smartphone transmission of ECG images to an interventional cardiologist (group 2, n = 44). Relevant time-points were recorded for analysis. ResultsThe time from ECG interpretation to CCL activation was reduced from 28.3 ± 4.1 in group 1 to 17.6 ± 2.3 min in group 2 (p = 0.03). Similarly, the time from ECG interpretation to balloon inflation time (D2B) decreased from 93.1 to 73.4 min (p = 0.025). Comparing group 2 with group 1, the door to balloon (D2B) time improved to 90.4 ± 9.8 from 119.3 ± 16.3 min (p = 0.23), the proportion of patients with a D2B time less than 90 min increased to 70.5% from 52.5% (p = 0.09), and the mortality rate decreased to 2.2% from 12.5% (p = 0.07). ConclusionThe additional use of a smartphone application to transmit ECG information to interventional cardiologists by EPs facilitated communication and reduced the decision time to CCL activation and percutaneous intervention.