Reduced door-to-balloon times in acute ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention

Abstract

Institution of an on-site cardiology team-based approach in the ED significantly reduces D2B time in STEMI patients eligible for primary PCI.

Does cardiac catheterization laboratory activation by electrocardiography machine auto-interpretation reduce door-to-balloon time?

“…In November 2006, Bradley et al [25] identified 6 strategies that were associated with reduced DTB times. Subsequently, a single page activation of the CCL by the EP was proposed as a strategy to reduce the DTB time [15,18,19,26,27,7,9,13]. Previous studies have shown that CCL activation by a single page improves DTB times [6,15,18,26,27], same as the result shown in our study.…”

“…Currently, the most widely used strategy is to activate the cardiac catheterization laboratory (CCL) through a single page. Several studies report that this system significantly reduced the DTB time [6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Based on this strategy, our institution implemented a 1-call "code heart I" protocol, CCL activation through a single page by emergency physician (EP).…”

Relationship between time of initial diagnosis of acute myocardial infarction to primary angioplasty on patient’s outcome

“…Investigation the correlation of time from initial assessment to emergency department until the onset of primary angioplasty with the final outcome in patients with acute myocardial infarction was evaluated in all studies included in the review. In majority of cases, primary angioplasty was achieved initiation time of less than 90 minutes from the initial assessment, resulting in better outcomes of patients (5,6,9,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). However, in case of performing culprit-vessel primary percutaneus coronary intervention before the unilateral or complete diagnostic angiography is associated with a statistically significant reduction in vascular access-to-balloon time, although the difference of 4-6 minutes is unlikely to be clinically relevant (22).…”

“…Approximately one in two AMI cases are fatal before admittance in hospital and occur more frequently within one hour of the onset of symptoms (26), whereas delayed onset of primary angioplasty by over two hours increases mortality (29). This review showed that in most cases primary angioplasty was achieved start within 90 minutes from the initial assessment, resulting in better outcomes of patients and agreement with the target time of guidelines (5,6,9,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21).…”

“…Direct transfer of patients with STEMI to the laboratory was associated with significantly lower primary angioplasty initiation times, faster reperfusion, and lower mortality risk in comparison with the first transfer to the emergency department (9). Another study showed that the establishment of a cardiological approach by a team of health professionals in the ED reduced the time of primary angioplasty in patients with STEMI (13). Also, the activation time of the laboratory to initiate post-evaluation PPCI appears to be lower at 8am-5pm (16), but a simultaneous electronic alert for the off-hours of the catheterization laboratory may reduce the time from entering PPCI and increasing the number of patients achieving target times (6) The performance of PPCI prior to contralateral or complete diagnostic angiography is associated with a statistically significant reduction in vascular access time (22), but not performing CT prior to primary PCI that changes clinical management in a very small percentage of patients (23).…”