BackgroundThe 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%.MethodsWe 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.ResultsA 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.ConclusionThere 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.

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Objectives: To investigate the influence of viability assessment in the management of patients with ischemic cardiomyopathy (ICM).Methods: This retrospective cohort study included all patients with ICM with moderate to severely reduced left ventricular ejection fraction (LVEF) who underwent viability assessment using cardiac magnetic resonance imaging (MRI) and echocardiogram as modalities of imaging. In addition, LVEF, modality of choice, and treatment plans were all extracted as main variables from the electronic database. One hundred 6 patients who met the inclusion criteria from December 2014 to December 2019 were included. Original ArticleResults: Posttreatment LVEF improved by 5% in the viable group compared to the nonviable group (p=0.016). Regardless of the treatment received, 6 (8.8%) patients in the viable group died due to cardiac causes after an 18-month follow-up period; in contrast, 7 (18.4%) patients died due to cardiac causes in the nonviable group. However, despite that difference, this was not statistically significant (p=0.153). Medical therapy alone was observed in 32 (84.2%) patients in the nonviable group compared to 32 (47.1%) in the viable group (p<0.001). Although the reduction in hospitalization for cardiac reasons was not statistically significant, the viable arm had 50% fewer hospitalizations than the nonviable arm (p=0.051). Conclusion:Patients with viable myocardium had better outcomes in which LVEF significantly improved posttreatment. Additionally, there was a reduction in the number of hospitalizations for cardiac reasons in the viable group compared to the nonviable group, even though the difference was not statistically significant. However, further studies with a larger number of patients are needed to determine a definite conclusion.