The Effect of Direct Communication Between Emergency Physicians and Interventional Cardiologists on Door-to-Balloon Times in STEMI

Abstract

We developed an institutional protocol mandating emergency physicians to contact the interventional cardiologist directly in all cases of ST-segment elevation myocardial infarction (STEMI) and hypothesized that this would reduce door-to-balloontimes (DTBT). From January 2004 to July 2006, 208 patients with STEMI were treated with primary percutaneous coronary intervention (PCI). A total of 144 patients were treated before implementing the new protocol (''before'') and 64 patients were treated after the implementation (''after''). The DTBT was significantly reduced from 148± ±101 min to 108± ±56 min (p<0.05). While only 25% of the ''before'' patients received PCI within 90 min after arrival, 50% of the ''after'' patients received PCI within 90 min (p<0.05). There were no significant differences between two groups in other outcomes (postprocedural TIMI flow, mortality, subsequent stroke, heart failure, shock, reinfarction, length of stay in intensive care unit, and the total hospital length of stay). In conclusion, mandating emergency physicians to directly notify interventional cardiologists of all STEMI patients reduces DTBT.

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

“…Previous studies have shown that ED physiciansdirected activation of the interventional cardiology team improves D2B times (9,11,17,22,23). Alternatively, in our on-site strategy, the cardiologist in the ED efficiently expedites diagnosis of STEMI and activation of the cath lab team for primary PCI in eligible patients.…”

“…Several potential clinical factors may be related to longer D2B times, including door-to-ECG time, catheterization laboratory (cath lab) activation time, cath team preparation time, and emergency department (ED) patient transfer time, as defined below. In the past few years, many studies have proposed different strategies to reduce D2B time in STEMI patients (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).Our institution is a 2000-bed tertiary care university hospital that has employed primary PCI for STEMI patients since 1996 with nearly all STEMI…”

Reduction of door‐to‐balloon time in patients with ST‐elevation myocardial infarction by single‐catheter primary percutaneous coronary intervention method

“…Reduced total ischemic time in STEMI has been reported using several methods such as pre-hospital electrocardiogram system, 11,15 emergency medicine physicians activating the catheterization laboratory, 22,23 or an attending cardiologist always on site. 24,25 These successful reports were based on pre-hospital and in-hospital transport. On the other hand, only a few reported attempts reduced PCI procedural times; for example, primary PCI without diagnostic angiography.…”

In‐hospital ‘CODE STEMI’ improves door‐to‐balloon time in patients undergoing primary percutaneous coronary intervention

“…6 A target of DTBT ≤90 min, in STEMI patients undergoing PPCI as the preferred reperfusion therapy, is widely adopted as the standard of care in the management of acute coronary syndromes (ACS). 7 Numerous strategies have been employed to meet this target, including ambulance field triage and notification, 8,9 direct communication between ED physicians and interventional cardiologists, 10 ED physician-led cardiac catheterisation laboratory activation 11 and having a 24 h inhospital interventional cardiology Correspondence: Associate Professor Jamie Layland, Department of Cardiology, Peninsula Health, PO Box 52, Frankston, VIC 3199, Australia. Email: jlayland@phcn.vic.…”