Door-to-Balloon Times from Freestanding Emergency Departments Meet ST-Segment Elevation Myocardial Infarction Reperfusion Guidelines (original) (raw)
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Door to Balloon Time in St-Segment Elevation Myocardial Infarction (STEMI): A Prospective Study
Cardiology and Angiology: An International Journal
Background: The most acute manifestation of coronary artery disease is ST-segment elevation myocardial infarction (STEMI) and is associated with mortality and morbidity. In the majority of cases, complete thrombotic occlusion develops from an atherosclerotic plaque in an epicardial coronary vessel is the cause of STEMI. Early diagnosis and immediate reperfusion reduce the risk of post-STEMI complications and heart failure and thereby are the most effective ways to limit myocardial ischemia and infarct size. If primary percutaneous coronary intervention (PCI) cannot be performed within 120 minutes of STEMI diagnosis, fibrinolysis therapy should be administered to dissolve the occluding thrombus and PCI has become the preferred reperfusion strategy in patients with STEMI. Methods: From the emergency section of the hospital in the month of October 2021, 7 adult patients were identified with ST-segment–elevation myocardial infarction undergoing primary percutaneous coronary. We used the...
Clinical Research in Cardiology, 2011
Background Guidelines recommend door-to-balloon times (DBTs) below 60 min for patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). The purpose of this study was to determine if an optimised STEMI-protocol reduces DBT and increases the number of patients to receive PCI within 60 min of hospital presentation. We hypothesised that DBT of \30 min can be accomplished for the majority of patients. Methods and results Between 2001 and 2008 data from 1,146 consecutive patients with acute STEMI admitted for primary PCI within 12 h after symptom-onset were analysed. Times to angioplasty from symptom-onset (pain-toballoon time, PBT) and from hospital arrival (DBT) to PCI and clinical outcomes were analysed. In the end of 2003 numerous strategies were implemented to reduce revascularisation times. These strategies resulted in a stable reduction of median DBT to 29 min [interquartile range (IQR) 22-39]. Overall, 94% of patients had median DBT \ 60 min and 56%\30 min. Consequently, PBT was significantly reduced from median 218 min (IQR 168-286) to 167 min (IQR 119-245) for non-transferred patients. Major cardiac adverse events (composite of congestive heart failure, reinfarction and cardiac death) were significantly associated with DBT [ 30 min and age, systolic blood pressure, anterior infarction, PBT [ 4 h, cardiogenic shock as well as multivessel disease. Conclusions A dedicated STEMI-protocol including several hospital strategies is feasible during daily clinical practice to decrease revascularisation times, results in a greater proportion of patients achieving guideline recommendations, and is associated with an improved clinical outcome.
ST-Segment Elevation Myocardial Infarction: Door to Balloon Time Improvement Project
Cardiology Research, 2016
Background: The purpose of this quality improvement project was to evaluate prospectively the causes of delay for patients with acute ST-segment elevation myocardial infarction (STEMI) requiring primary percutaneous coronary intervention (PCI) upon arrival at the emergency department (ED) and implement recommendations to reduce delays and analyze the impact of recommendations to reduce the door-to-balloon (D2B) time in a newly established cardiac center (King Faisal Cardiac Center (KFCC)). Primary PCI has developed as an effective treatment strategy for acute STEMI, the survival rate and patient outcome are however dependent on the time to treatment. The international benchmark for all programs dealing with acute coronary syndrome patients suffering from STEMI has been established as 90 minutes or less from the time the patient arrives at the hospital to the opening of the affected vessel in the cardiac catheterization laboratory "door-to-balloon time" or D2B. In KFCC during the year 2014, the STEMI, D2B time of ≤ 90 minutes was achieved in 25%. Methods: We conducted a single center prospective data collection for consecutive patients presenting with STEMI within 24 hours of the onset of chest pain between January 2015 and December 2015. The boundaries of the process began when the patient entered the emergency department and ended when the balloon was inflated during the PCI. Certain well-defined metrics were chosen to drive the change and identify the defect. Results: A total of 37 patients presented with STEMI. The number of patients who achieved the target D2B time ≤ 90 minutes was 20 (54%). Nine patients (24.4%) had D2B time between 91 and 120 minutes and eight patients (21.6%) beyond 120 minutes. The delays were due to late identifications of patients with chest pain as well as in obtaining ECG, activation and transport to the catheterization laboratory. Conclusion: There was a measurable improvement up to 54%. Several factors have contributed to the delays in achieving the goal standard of above 90%; these include late identifications of patients with STEMI, delays in obtaining the ECG, activation of the catheterization laboratory and delay of patients' transportation.
Door-to-Balloon Time for Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction
Hospital Chronicles, 2012
Over the recent years it has become clear that reperfusion by primary coronary intervention in patients with ST elevation myocardial infarction (STEMI) is superior to thrombolytic therapy and is the treatment of choice. However, this reperfusion strategy has some drawbacks, as cardiac catheterization laboratories are not always widely available 24 hours/7 days and long-time delays related to primary percutaneous coronary intervention (pPCI) could have negative impact on mortality. The shorter the delay from symptom onset to reperfusion, the greater the amount of the myocardium rescued as it is obvious that "time is muscle". Among pPCI related times the crucial time delay is the "door-to-balloon time", which is the time from arrival at the hospital until the mechanical restoration of the vessel patency. This time delay is usually accurately recorded and depends on the national (or even local) health care system. The European Society of Cardiology guidelines on myocardial revascularization suggest that total ischemic time should not exceed 120 min and especially 90 min for patients <65 years old, with anterior infarction and early presentation (<2 hours) from onset of symptoms, because these categories of patients have even worse outcomes and increased mortality with prolonged door-to-balloon times, compared to other categories. Better education of the patient about symptoms suggesting myocardial ischemia, pre-hospital diagnosis of STEMI based on 12-lead electrocardiogram with immediate transportation to a PCI-capable center in order to eliminate inter-hospital delays, an effective emergency medical system capable of quick transportation, immediate activation of the cardiac catheterization laboratory from emergency physicians or an attendant cardiologist, the presence of an experienced team of high volume operators and skilled supporting staff capable of performing PPCI 24 hours/7 days, new and more effective antithrombotic drugs and angioplasty materials, are the key elements to achieve shorter door-to-balloon and PCI delay times and therefore to save the greatest amount of myocardium and reduce mortality.
Annals of Emergency Medicine, 2007
We seek to evaluate how accurately the emergency physician initiates percutaneous coronary intervention for patients presenting to the emergency department (ED) with ST-segment-elevation myocardial infarction (STEMI) and the impact of emergency physician-initiated percutaneous coronary intervention on mean door-to-balloon time. We conducted a before-and-after cohort study of consecutive STEMI patients presenting to a 608-bed tertiary care hospital during a 32-month period. During the first 19 months, percutaneous coronary intervention was available only by consultation with an on-call interventionist. In the subsequent 13 months, percutaneous coronary intervention was initiated by the emergency physician independent of cardiology consultation. All patients presenting during the study period with an appropriate clinical history and characteristic ECG findings of STEMI were eligible. Patients with greater than 12 hours of symptoms, contraindications to percutaneous coronary intervention, a valid do-not-resuscitate order, who died before percutaneous coronary intervention was attempted, who initially refused, or whose door-to-balloon time was greater than 6 hours were excluded. The accuracy of emergency physician identification of STEMI was confirmed by an independent cardiologist. All hospital medical records with a discharge diagnosis of acute myocardial infarction (International Classification of Diseases, Ninth Revision code 410.xx) were reviewed to confirm that no STEMI patients went unidentified. A t test was used to compare mean door-to-balloon time in each cohort. A total of 172 patients were enrolled in this investigation, 95 STEMI patients in the initial 19-month period and 77 patients in the subsequent 13 months, when percutaneous coronary intervention was initiated solely at the discretion of the emergency physician. Percutaneous coronary intervention was inappropriately initiated by the emergency physician only once, and no ED patients with STEMI were overlooked, resulting in 100% sensitivity (95% confidence interval [CI] 97.3% to 100%) and 99.6% specificity (95% CI 97.7% to 99.9%). Mean door-to-balloon time in the emergency physician-initiated percutaneous coronary intervention cohort improved by 40 minutes (95% CI 26 to 54 minutes) from 131 to 91 minutes. The emergency physician is able to accurately initiate percutaneous coronary intervention for ED patients presenting with STEMI independent of cardiology consultation. Emergency physician-initiated percutaneous coronary intervention significantly reduces mean door-to-balloon time for these patients.
Catheterization and Cardiovascular Interventions, 2010
Objectives: This study compares the transradial versus the transfemoral approach for time to intervention for patients presenting with ST elevation myocardial infarction (STEMI). Background: Survival following STEMI is associated with reperfusion times (door-to-balloon; D2B). For patients undergoing primary PCI for acute STEMI, potential effects of transradial approach (r-PCI) as compared with the femoral artery approach (f-PCI) on D2B times have not been extensively studied. Methods: Consecutive patients presenting with STEMI at a tertiary care medical center were enrolled in a comprehensive-Heart Alert program (HA) and included in this analysis. Time parameters measured included: door-to-ECG, ECG-to-HA activation, HA activation-to-cath lab team arrival, patient arrival in cath lab to arterial access, and arterial access-to-balloon inflation. Results: Of 240 total patients, 205 underwent successful PCI (n 5 124 r-PCI; n 5 116 f-PCI). No significant difference was observed in the pre-cath lab times. Mean case start times for r-PCI took significantly longer (12.5 6 5.4 min vs. 10.5 6 5.7 min, P 5 0.005) due to patient preparation. Once arterial access was obtained, balloon inflation occurred faster in the r-PCI group (18.3 vs. 24.1 min; P < 0.001). Total time from patient arrival to the cardiac cath lab to PCI was reduced in the r-PCI as compared to the f-PCI group (28.4 vs. 32.7 min, P 5 0.01). There was a small but statistical difference in D2B time (r-PCI 76.4 min vs. f-PCI 86.5 min P 5 0.008). Conclusions: Patients presenting with STEMI can undergo successful PCI via radial artery approach without compromise in D2B times as compared to femoral artery approach.