Mean Door-to-balloon Time Research Articles

Door-to-Balloon Time in ST-Elevation Myocardial Infarction (STEMI) Patients Undergoing Primary Angioplasty in Myocardial Infarction (PAMI): An Observational Study From a Tertiary Care Centre.

Background ST-elevation myocardial infarction (STEMI) requires swift intervention, with primary percutaneous coronary intervention (PCI) being essential to limit myocardial damage. The key factor affecting PCI effectiveness is the door-to-balloon (DTB) time. This observational study evaluated DTB times in STEMI patients at a tertiary care center who underwent primary angioplasty, examining adherence to benchmarks and identifying factors contributing to delays. Methodology This prospective observational study was conducted from March 2017 to August 2018 at Fortis Hospital Mulund, Mumbai, India. It included 171 STEMI patients aged 18 and older who underwent primary angioplasty. Patients with non-ST elevation myocardial infarction (NSTEMI), those who received thrombolysis, or had medical contraindications to primary angioplasty were excluded. Data on key time intervals were collected via direct observation and then analyzed using SPSS for Windows, Version 15 (Released 2006; SPSS Inc., Chicago, United States). Qualitative data were summarized using frequency and percentages, whereas quantitative data were presented as mean (±SD). T-test was applied to compare the mean duration between the two groups, i.e., DTB time ≤90 minutes and DTB time >90 minutes, and a p-value <0.05 was considered statistically significant. Results The participants had a mean age of 56.5 (±13.1) years and were predominantly male (78.4%). The mean DTB time was 70.21 (±29.16) minutes, with 79.5% achieving ≤90 minutes. Patient-related delays (48.6%) were mainly due to consent issues (31.4%), which was the most predominant cause. Hospital-related delays (51.4%) included catheterization laboratory occupancy (14.3%) and diagnostic delays (14.3%). Patients with DTB times >90 minutes had significantly longer durations in all procedural steps except door-to-ECG time. Conclusion This study underscores the complex challenges in achieving timely DTB times for STEMI patients undergoing primary angioplasty. Overcoming these barriers through targeted interventions is essential for optimizing management and enhancing outcomes. Insights into delay factors inform evidence-based strategies to improve the timeliness and effectiveness of STEMI care delivery.

Variations and Associated Factors in Symptom-to-Balloon (STB) Time and Door-to-Balloon (DTB) Time Before and After the COVID-19 Lockdown: A Hospital-Based Cross-Sectional Study.

During the COVID-19 lockdown, India saw a major restriction in the movement of people. Patients with acute myocardial infarction (MI) required early interventions and follow-up of independent predictors like symptom-to-balloon (STB) time and door-to-balloon (DTB) time. This study aimed to determine changes in STB and DTB time before and after the COVID-19 lockdown and its associated risk factors. A hospital-based cross-sectional study of 105 patients admitted to the cardiac care units (CCU) of two tertiary care centers in a district of Southern India for six months was conducted to compare the changes in STB and DTB time before and after the COVID-19 lockdown (three months before March 2020 and three months after March 2020), and data was collected from medical records. The data collected was then entered into Microsoft Excel (Microsoft Corporation, Washington, USA), numerically coded, and analyzed using SPSS Statistics version 21 (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.). The Chi-square and Mann-Whitney U tests assessed the association between the dependent and independent variables. The STB/DTB time (before and after the COVID-19 lockdown) was the dependent variable, while the age, gender, co-morbidities, smoking status, and date of admission of patients (before and after the COVID-19 lockdown) were taken as the independent variables. A p-value of <0.05 was considered statistically significant. The predictor variables were identified using the regression method, where all variables with a significance of <0.2 were taken. The overall mean (±SD) STB time was 408.7 (±307.1) minutes, and the mean (±SD) DTB time was 161.7 (±261.6) minutes. The pre-lockdown mean STB time was 404.6 minutes, and the mean DTB time was 153 minutes, whereas the post-lockdown mean STB and DTB time were higher at 413.3 minutes and 171.6 minutes, respectively. Out of the total 105 patients, 95 (90.5%) had an STB time of ≥120 minutes, and 77 (73.3%) had an ideal DTB time of <90 minutes. There was no statistically significant variation in the STB and DTB time before and after the lockdown. Only the age group >60 years (38 (97.4%)) was found to be statistically significant with an STB time of ≥120 minutes after the lockdown (p-value=0.040), and patients referred from primary and secondary care centers (AOR (95% CI)=4.669 (1.129-19.298)) were found to be an independent factor in reducing DTB time before and after the COVID-19 lockdown. The efficiency of the health system, irrespective of the COVID-19 lockdown, was observed; nevertheless, a delay in the overall recognition of symptoms of MI was perceived. The importance of time factors in identifying the symptoms of non-communicable diseases (NCDs), especially MI and stroke, has to be ascertained among the general population.

Predictors and Clinical Outcomes of Crossover From Radial to Femoral Access During Primary Percutaneous Coronary Intervention.

Access site complications are more common with femoral access (FA) than radial access (RA). However, due to the higher rate of failure and crossover, door-to-balloon time (DBT) is prolonged by RA. Records of 3600 patients who underwent primary percutaneous coronary intervention (pPCI) between January 2016 and June 2019 were retrospectively reviewed. A total of 130 patients with crossover from RA to FA were identified and compared with the data of 501 patients who underwent pPCI with successful RA during 2018. Regression analysis was performed to determine the predictors of crossover. Crossover to the femoral approach occurred in 5.9% of our cases. Mean DBT was 17 minutes longer in the crossover group (61 ± 72 minutes vs 78 ± 79 minutes, P = .026). Female sex (odds ratio [OR]: 1.8; 95% CI, 0.99-3.46, P = .046) and anterior myocardial infarction (AntMI; OR: 0.52; 95% CI, 0.33-0.88, P = .007) were independent predictors of crossover. In-hospital mortality rates were significantly higher in the crossover group than in the radial success group (5.4% vs 1.8%, P = .020). Crossover to FA due to radial failure is associated with delayed DBT and increased rate of in-hospital mortality. Female sex and AntMI were primary predictors of crossover.

ST-Segment Elevation Myocardial Infaction Alert During the Night Shift, A Misfortune for the Patient or an Overstatement?

BackgroundConflicting data exist regarding the outcomes of primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) based on intervention timings. It is believed that short staffing at night hours may lead to a lapse in the delivery of effective, efficient and timely medical intervention.MethodsA retrospective single-center study was performed, and a total of 436 patients were randomized into two groups. Group A had 279 patients who had the heart catheterization done during the daytime (between 6 am and 6 pm), while group B had 157 patients who had the same intervention performed at night (between 6 pm and 6 am).ResultsDoor to balloon (DTB) time during the day was about 16 min shorter than the DTB time at night (81.29 ± 3.26 vs. 97.30 ± 8.54) with no statistical difference (P = 0.051). The mean troponin rise during the day was 1.94 ± 10.60 SEM (95% confidence interval (CI): -22.70 to 18.90) higher than night troponin levels (71.75 ± 7.18 vs. 69.80 ± 7.18), but P value was 0.85. The left ventricular ejection fraction (LVEF) fall for daytime was 0.93% vs. 0.90% for night time patients (P = 0.94).ConclusionThere is no significant difference in the mean DTB time, the rise in troponin, fall in LVEF, readmission rates, or mortality, and hence no negative effects on patient outcomes based on the patient’s time of presentation between the two groups.

Retrospective Non-Randomised Study of STEMI Management Pre and Post Participation in the Victorian Cardiac Outcome Registry

Introduction: This is a retrospective, non-randomised study to evaluate improvement in quality of care due to participation in the Victorian Cardiac Outcome Registry (VCOR) at Mulgrave Private Hospital, Victoria. We compared data from all STEMI presentations in 2015 (pre VCOR) and 2018 (during VCOR). International guidelines benchmark 90 minutes for best practice door-to-balloontime (DTBT). Results: Close auditing of each interval was initiated during the 2018 VCOR era. Average door to cathlab time was +9.1 min (2015) and −8.2 min (2018), with the negative value denoting lab activation prior to arrival. For Ambulance Victoria pre-hospital notification patients, the comparison was 21.5 min (2015) and 14.6 min (2018). Average Door to cathlab activation also improved by 8 minutes (2015: 20.3 min; 2018: 12.5 min). Mean DTBT was longer in 2018 (106 mins) compared to 2015 (73.5 mins) but can be attributed to clinical complexity. Median DTBT was improved by 7 minutes (59 mins). Door to triage time also improved (2015: 9.75 mins; 2018: <2 mins). Conclusion: Closer auditing as a direct involvement with VCOR can identify where resources are required to achieve a DTBT <90 minutes. Cathlab is now activated earlier and DT to triage has reduced in 2018. While achieving DTBT 75% <90 minutes in both 2015 and 2018, increased visibility during VCOR involvement points to heightened proactivity in reducing DTBT aiming for improved outcomes for STEMI patients.

Door-to-balloon time and cardiac mortality in acute myocardial infarction by total occlusion of the left circumflex artery.

Acute myocardial infarction (AMI) caused by total occlusion of the left circumflex artery (LCX) can present as non-ST-segment elevation myocardial infarction (NSTEMI). We evaluate whether door-to-balloon time (DBT) is associated with cardiac mortality in patients with total occlusion of the LCX. From the Korea Acute Myocardial Infarction Registry, patients with AMI who had total occlusion with a Thrombolysis In Myocardial Infarction flow grade of 0 were included. We determined the factors for delay in primary percutaneous coronary intervention (DBT>90 min) and evaluated cardiac mortality for a median period of 14 months. Mean DBT was 68 min (interquartile range=50-156 min), and the achievement rate of DBT less than or equal to 90 min was 66.9% in the entire study population. More than half of patients with total occlusion of LCX were presented as NSTEMI (57.7%). Among patients with total occlusion of the LCX, the mean DBT was 136 min (interquartile range=60-484 min), and the achievement rate of DBT less than or equal to 90 min was 42.8%. On multivariate analysis, LCX occlusion was an important factor for DBT more than 90 min (odds ratio: 1.766, P<0.001). Among patients with LCX occlusion, cardiac mortality was higher in patients with ST-segment elevation (6.2 vs. 11.0%, P=0.024). This study showed that LCX occlusion was a significant factor for the delay in primary percutaneous coronary intervention on account of presenting as NSTEMI. Cardiac mortality was not associated with DBT more than 90 min but with ST-segment elevation in AMI patients with total occlusion of the LCX.

Impact of shorter door-to-balloon time on prognosis of patients with STEMI-single-center analysis with a large proportion of the patients treated within 30min.

Several recent studies suggested that the door-to-balloon time (DTBT) for patients with ST-segment elevation myocardial infarction (STEMI) should be as short as possible, despite the existing guideline for STEMI. This study aimed to evaluate the clinical outcomes of the STEMI patient cohort having the highest proportion of patients treated with a DTBT of ≤ 30 min ever reported. We evaluated 527 consecutive patients with STEMI who underwent percutaneous coronary intervention between 2007 and 2015. The mean age was 68.0 ± 12.7years, and the mean DTBT was 44.4 ± 33.1min. The patients were classified into four groups according to the DTBT, and the relationship between the DTBT and clinical outcome was investigated. DTBTs were ≤ 30min in 146 patients (27.7%), 31-60min in 297 patients (56.4%), 61-90min in 60 patients (11.4%), and > 90min in 24 patients (4.6%). In-hospital mortality rates were 0.7, 5.0, 11.7, and 12.5% for DTBTs of ≤ 30, 31-60, 61-90, and > 90min, respectively. In multivariate analysis, a DTBT ≤ 30min (odds ratio [OR] 0.11, 95% confidence interval [CI] 0.01-0.91, p = 0.041), shock on arrival (OR 2.74, 95% CI 1.02-7.37, p = 0.046), and blood transfusion (OR 49.60, 95% CI 13.90-177.00, p < 0.001) were the independent predictors of in-hospital mortality. Patients with STEMI treated with a DTBT ≤ 30min showed significantly better clinical outcomes than those treated with a DTBT > 30min.

26 Feasibility of therapeutic hypothermia in stemi: single UK heart attack centre experience

Background Primary PCI is the gold standard treatment for acute STEMI, but reperfusion injury limits its beneficial effect on infarct size (IS). In experimental studies, therapeutic hypothermia (HT) consistently reduces IS caused by reperfusion injury, but translation into clinical practice remains a challenge. The purpose of our study (part of COOL AMI EU study) was to assess the feasibility of integrating pre-reperfusion HT using an intravascular temperature management system (Thermogard XP, ZOLL, USA) into routine clinical practice without a significant delay in door-to-balloon (DTB) time. Methods Patients with STEMI presenting within 6 h of symptoms onset and planned for PPCI were prospectively enrolled. TH was implemented by intravenous infusion (IV) of cold saline and a heat-exchange balloon catheter inserted via the right femoral vein. Oral buspirone and IV pethidine were used to control shivering. HT was continued for a total time of 3 h, followed by passive rewarming. Results 18 patients were successfully recruited. The average age was 60.3 years and 94.4% were male. The DTB time was 40.6 min. There was an increase of 3.6 min compared with the mean DTB time of 37 min for patients who underwent PPCI and did not received HT. Mean temperature at reperfusion was 34.4 ° C. There were no adverse events related to the use of the heat-exchange catheter or the implementation of hypothermia. Conclusion Hypothermia is feasible and safe in STEMI patients without significant delay in door-to-balloon time.

Impact of a novel interventional platform and hospital design on the door-to-balloon time in patients presenting with ST-segment elevation myocardial infarction.

Reducing door-to-balloon (DTB) time in ST-segment elevation myocardial infarction improves outcomes. Several hospital factors can delay DTB times and lead to increased morbidity and mortality. The effects of hospital design and an interventional platform (IP) on patient care, particularly on the DTB time, are unknown. We performed a retrospective analysis of consecutive patients presenting to the emergency department of a medical center from September 2010 to February 2014 who met criteria for a ST-segment elevation myocardial infarction and underwent primary percutaneous coronary intervention. Patients were divided into 2 groups based on whether they presented before or after the opening of the IP in our new hospital on January 6, 2012. Total DTB time and separate systematic intervals were tabulated. Fifty-two patients met our inclusion criteria, 21 pre-IP and 31 post-IP. Both groups had overall similar baseline characteristics. The mean DTB time significantly improved by 11.7 minutes after the opening of the IP (P = 0.016), and all cases had a DTB time 90 minutes or less as compared with 90.4% prior. Eighty-nine percent of the overall improvement in DTB happened before the patient reached the catheterization table. Important factors were the new emergency department (ED) design that facilitates rapid patient triage and the direct connection between the ED and cath lab. This study showed that the new hospital design had significant effects on immediate patient care by improving the DTB time at our institution. Further study regarding the long-term impact of hospital designs on patient care is needed.

Trans-radial primary percutaneous coronary intervention in ST-elevation myocardial infarction.

To study the effect of trans-radial approach (TRA) on achievement of a door-to-balloon time (DBT) of ² 90 minutes in primary PCI percutaneous Coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI). Case series. Armed Forces Institute of Cardiology - National Institute of Heart Diseases (AFIC -NIHD), Rawalpindi, from October 2011 to August 2012. Systems goal for door-to-balloon time (DBT - time elapsed between first medical contact and restoration of flow in the infarct related artery [IRA]) was set at < 90 minutes. Procedural success was defined as restoration of TIMI 3 flow in the IRA with less than 30% residual stenosis and discharge from hospital. Non-infarct related arteries were not treated. Bleeding episodes were defined by TIMI definitions. For vascular access for PPCI in a total of 207 patients, TRA was 91.3% (n = 189), transfemoral approach (TFA) 6.3% (n = 13) and brachial 2.4% (n = 5). Males represented 90.3% of cases and 7% were females. Mean age was 55 ± 10.86 years. Procedural success rate was 97.1%. Mean DBT was 54.1 minutes. DBT was less ² 60 and 90 minutes in 75% and 94.2% of patients respectively. DBT ² 89.50 minutes was achieved in 90% of patients. The difference in DBT between the different access groups was not markedly different between the three groups. There were 6 (2.9%) in-hospital deaths and no major bleeds. TRA for PPCI poses no hindrance to achieving a DBT of < 90 minutes in PPCI for STEMI. Furthermore, the in-hospital mortality rates are acceptable and within rational limits.

Quality improvement in the door‐to‐balloon times for ST‐elevation myocardial infarction patients presenting without chest pain

To assess a quality improvement initiative aimed at minimizing door-to-balloon (DTB) times for ST-elevation myocardial infarction (STEMI) patients presenting without chest pain. Timely percutaneous coronary intervention (PCI) is the cornerstone of STEMI care. The absence of chest pain delays PCI. Improvements in DTB times may need to focus on atypical presentation patients. We compared DTB times on all STEMI patients admitted through the emergency department who underwent PCI before (Phase I; October 2004-June 2007) and after (Phase II; July 2007-October 2009) the quality improvement effort, which mandated rapid electrocardiogram (ECG) triage for an expanded list of presenting symptoms. In Phase I (69 patient, 60 with chest pain), patients with chest pain had a shorter mean time to first ECG (ECG Interval) by 32.0 min (P < 0.01) and nonsignificantly faster mean DTB time by 42.0 min (P = 0.07) compared to patients who presented without chest pain. In Phase II (62 patients, 56 with chest pain) compared to Phase I, mean ECG interval decreased by 44 min (P = 0.02) and mean DTB time by 99 min (P = 0.01) in patients without chest pain, eliminating the differences in ECG intervals between typical and atypical presentations (12 min vs. 11 min, P = 0.91). Multivariable analysis controlling for on/off hours and patient characteristics confirmed these findings. A simple modification of emergency room ECG triage protocol, which expands indications for rapid ECG performance, was successful in improving rapid reperfusion for patients with STEMI presenting without chest pain.

The Dissociation Between Door-to-Balloon Time Improvement and Improvements in Other Acute Myocardial Infarction Care Processes and Patient Outcomes

Recent initiatives have focused on reducing door-to-balloon (DTB) times among patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. However, DTB time is only one of several important AMI care processes. It is unclear whether quality efforts targeted to a single process will facilitate concomitant improvement in other quality measures and outcomes. This study examined 101 hospitals (43 678 patients with AMI) in the Get With the Guidelines program. For each hospital, DTB time improvement from 2005 to 2007 was correlated with changes in composite Centers for Medicare and Medicaid Services/Joint Commission on Accreditation of Healthcare Organizations (CMS/JCAHO) core measure performance and in-hospital mortality. Between 2005 and 2007, hospital geometric mean DTB time decreased from 101 to 87 minutes (P < .001). Mean overall hospital composite CMS/JCAHO core measure performance increased from 93.4% to 96.4% (P < .001), and mortality rates were 5.1% and 4.7% (P = .09) in the early and late periods, respectively. Improvement in hospital DTB time, however, was not significantly correlated with changes in composite quality performance (r = -0.06; P = .55) or with in-hospital mortality (r = 0.06; P = .58). After adjustment for patient mix, hospitals with the most improvement in DTB time did not have significantly greater improvements in either CMS/JCAHO measure performance or mortality. Within the Get With the Guidelines program, DTB times decreased significantly over time. However, there was minimal correlation between DTB time improvement and changes in other quality measures or mortality. These results emphasize the important need for comprehensive acute myocardial infarction quality-improvement efforts, rather than focusing on single process measures.

Comment on “A Bayesian Sensitivity Analysis of Out‐of‐Hospital 12‐Lead Electrocardiograms: Implications for Regionalization of Cardiac Care”

I read with interest the article by Youngquist et al. suggesting that the low pretest probability of ST-elevation myocardial infarction (STEMI) in out-of-hospital patients with ischemic symptoms, combined with an imperfect electrocardiogram (ECG) specificity for STEMI, will unacceptably lower the positive predictive value of an out-of-hospital ECG. In April 2005 when we set up our system for out-of-hospital activation, without any base physician involvement, we required both a computer-aided ECG diagnosis of **Acute MI** and the presence of chest pain. Dyspnea, cardiac arrest, or any other presentation that did not include chest pain was not adequate for the paramedic decision to activate the catheterization laboratory. Through July 2007, we had 55 patients with STEMI correctly activated by the emergency medical services (EMS) and only four false-positive activations, for a positive predictive value of 93%. Since January 2004, a total of 68 of 104 (65%) STEMI patients transported by EMS would have been eligible for activation based on these criteria. The mean doorto-balloon time with out-of-hospital activation decreased from 86 to 56 minutes for those who have chest pain and **Acute MI** by the algorithm. doi: 10.1111/j.1553-2712.2008.00089.x Stephen W. Smith, MD (smith253@umn.edu) Hennepin County Medical Center and Department of Emergency Medicine University of Minnesota School of Medicine Minneapolis, MN Hennepin County Medical Center, EMS Minneapolis MN

Abstract 2405: Effect of Early Emergency Room Notification on Door-to-Balloon Time in Patients Presenting with ST Elevation Myocardial Infarction

Background: The goal of mechanical reperfusion therapy in the setting of ST Segment Elevation Myocardial Infarction (STEMI) is to re-establish blood flow to the affected vascular bed as quickly as possible. Primary angioplasty has been shown to be superior to fibrinolysis when door-to-balloon (DTB) time is less than 60 minutes. The median DTB time in the United States is 185 minutes and only 3% of patients are currently being mechanically reperfused within the 90 minutes as recommended by American College of Cardiology guidelines. The purpose of this study is to see if an aggressive approach involving emergency medical services (EMS), emergency room (ER) personnel, and the early activation of cardiac interventional team could improve reperfusion times. We evaluated the feasibility of pre-hospital Electrocardiogram (phECG) to triage patients with STEMI directly to the cardiac catheterization laboratory (CCL) compared to the standard therapy at two primary PCI centers Methods: The EMS personnel obtained a 12-lead ECG during initial assessment in the field from patients with symptoms of myocardial infarction. The ECG was immediately transmitted to the ER physician by cellular link to a computer receiving station located in the ER. The ER physician reviewed the 12-lead ECG digital tracing. The cardiac catheterization laboratory (CCL) team was activated from the patients’ homes. Patients were transported from the field directly to the CCL by EMS bypassing ER admission. Results: From Oct 2003 to May 2007, 142 consecutive patients with STEMI who presented to Providence Hospital and Medical Centers were included in the study. The conventional treatment group (125 patients) had a mean DTB time of 123 minutes. We identified 359 phECGs transmitted to the ER, 43 of which had inadequate transmission signal. Adequate phECG transmission was detected in 88% cases. We diagnosed 17 patients with STEMI by phECG who were included for the analysis. The mean DTB time was significantly lower in patients diagnosed using phECG (46 minutes vs. 123 minutes, p&lt;0.001). Conclusion: Utilizing the phECG as a tool to bypass ER triage significantly decreases DTB times in patients with STEMI. This technology has the potential to substantially expedite reperfusion therapy in patients with STEMI.

Abstract 2403: Effect Of Prehospital Cath Lab Activation On Door To Balloon Time Of STEMI Patients Presenting During Normal Workday Hours vs. After Hours

BACKGROUND : We significantly reduced door-to-balloon-time (DBT) after instituting prehospital cath lab activation for STEMI, without EKG transmittal or MD involvement. OBJECTIVE: To study the effect of the protocol on DBT in normal workday hours (cath lab team is in-house) vs. after-hours (cath lab team is not in-house). METHODS : For all STEMI patients (pts), data are collected prospectively. Since 2001 all pts transported by our institution’s EMS, with symptoms suggesting MI, have had prehospital EKG. In April 2005, we started the following additional protocol (with no other changes in our acute MI program): if the chief complaint is Chest Pain and the Zoll® M Series Interpretive EKG (Marquette 12SL algorithm) reads ``**Acute MI**,” Paramedics call the ED unit coordinator from the scene to activate the cath lab without MD involvement. For all EMS transported pts from Jan 2004 to Jan 2007, we analyzed demographics, symptoms, Zoll interpretation, door-to-EKG-time, and DBT. We compared the time saved before and after protocol change for normal workday hours vs. after hours. Statistics were by Kruskal Wallis and the two-tailed Fisher Exact test. RESULTS: There were 104 patients with STEMI transported in the time period. 36 were excluded: 26 with no chest pain (14 cardiac arrest), 8 with a non-diagnostic Zoll EKG and 2 others. Of 68 eligible patients (65% of all STEMI), 36 had prehospital activation (20 workday, 16 after hours) and 32 did not get prehospital activation (12 Workday and 20 after hours). See table for results. Overall mean DBT was reduced from 86.0 ± 9.6 (CI) min. in the before group to 56.1 ± 7.7 min. in the prehospital activation group. CONCLUSION : Prehospital activation significantly reduces DBT in STEMI patients presenting during both normal workday hours and after hours. Significant time savings and exceptionally short DBTs (&lt; 60 min) were achieved by prehospital activation for STEMI patients presenting during normal workday hours.

A Rapid-Response Alphanumeric Paging Design Decreases Door-to-Balloon Times in Patients Undergoing Primary Percutaneous Coronary Intervention for ST Elevation Acute Myocardial Infarction

In acute ST elevation myocardial infarction (STEMI), rapid reperfusion of the infarcted artery improves cardiovascular outcomes; however, many hospitals have difficulty achieving recommended times. We hypothesized that a Rapid-Response Alphanumeric Paging Design (RAPiD) would reduce door-to-balloon time for primary percutaneous coronary intervention (PCI) in STEMI. A chest pain algorithm and interdisciplinary team was established in December 2000. In August 2002, RAPiD was instituted to transmit the diagnosis and location of a STEMI to the chest pain team through a speed-dial button. All patients presenting to our emergency department from February 2002 through July 2003 with STEMI were included. Exclusion criteria included lack of chest pain, cardiopulmonary arrest before PCI, and catheterization or PCI not performed. Outside-referral STEMI, in-patient STEMI, and failed thrombolysis patients were excluded. Data was obtained from medical records. Log transform of door-to-balloon (DTB) times was performed. Forty-seven events satisfied inclusion and exclusion criteria with 32 occurring after RAPiD (post-RAPiD). Fifteen events occurred during on-hours (8 am to 7 pm on weekdays). Mean untransformed DTB times pre- and post-RAPiD were 162 +/- 137 (standard deviation) minutes and 112 +/- 41 minutes. The main effects analysis of variance model showed a significant reduction in post-RAPiD DTB time (P = 0.03) with a mean reduction of 26% during off-hours and 20% during on-hours. The post-RAPiD estimate of mean DTB time, derived from the antilog of the log transform, was 96.7 minutes (95% confidence interval, 83.7-111.7). The institution of RAPiD in a hospital with a preexisting chest pain algorithm significantly decreases DTB times so as to satisfy current ACC/AHA guidelines.