Reduction of Door-to-Balloon Time by New Performance Processes in Patients With ST-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
Restricted accessOtherFirst published online April, 2011
Reduction of Door-to-Balloon Time by New Performance Processes in Patients With ST-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
The aim of this study was to determine whether the adoption of new performance processes reduced the door-to-balloon time for primary percutaneous coronary intervention (PCI). To reduce the door-to-balloon time, we adopted 3 new performance processes: concurrent activation at the emergency department rather than stepwise activation; direct phone call rather than using a pager or message; patient transferred to catheterization laboratory before the PCI team arrive. A total of 139 consecutive patients were compared before and after the new performance processes. After the adoption of the new processes, median door-to-balloon time reduced significantly from 133 to 76 minutes (P < .0001) and patients undergoing primary PCI within 90 minutes increased significantly from 16% to 72% (P < .0001). Among the subdivisions of the door-to-balloon time, door-to-consent time and door-to-laboratory arrival time decreased significantly (50.0 vs 20.5 minutes, P < .0001; 95.0 vs 40.0 minutes, P < .0001, respectively).
Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: executive summary: a report of the ACC/AHA Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines on the Management of Patients with Acute Myocardial Infarction). Circulation . 2004;110(5):588-636.
2.
De Luca G., Suryapranata H., Zijlstra F., et al. Symptom-onset-to-balloon time and mortality in patients with acute myocardial infarction treated by primary angioplasty. J Am Coll Cardiol. 2003;42(6):991-997.
3.
Antoniucci D. , Valenti R., Migliorini A., et al. Relation of time to treatment and mortality in patients with acute myocardial infarction undergoing primary coronary angioplasty. Am J Cardiol. 2002;89(11):1248-1252.
4.
Cannon CP, Gibson CM, Lambrew CT, et al. Relationship of symptom-onset-to-balloon time and door-to-balloon time with mortality in patients undergoing angioplasty for acute myocardial infarction. JAMA. 2000;283(22):2941-2947.
5.
Brodie BR, Stone GW, Morice MC, et al. Importance of time to reperfusion on outcomes with primary coronary angioplasty for acute myocardial infarction (results from the Stent Primary Angioplasty in Myocardial Infarction Trial). Am J Cardiol . 2001;88(10):1085-1090.
6.
Zijlstra F., Patel A., Jones M., et al. Clinical characteristics and outcome of patients with early (<2 h), intermediate (2-4 h) and late (>4 h) presentation treated by primary coronary angioplasty or thrombolytic therapy for acute myocardial infarction. Eur Heart J. 2002;23(7):550-557.
7.
McNamara RL, Wang Y., Herrin J., et al. Effect of door-to-balloon time on mortality in patients with ST-segment elevation myocardial infarction. J Am Coll Cardiol . 2006;47(11):2180-2186.
8.
Keeley EC, Boura JA, Grines CLPrimary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet. 2003; 361(9351):13-20.
9.
Andersen HR, Nielsen TT, Rasmussen K., et al. A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction. N Engl J Med. 2003;349(8):733-742.
10.
Bradley EH, Herrin J., Wang Y., et al. Strategies for reducing the door-to-balloon time in acute myocardial infarction. N Engl J Med. 2006;355(22):2308-2320.
11.
Kraft PL, Newman S., Hanson D., Anderson W., Bastani A.Emergency physician discretion to activate the cardiac catheterization team decreases door-to-balloon time for acute ST-elevation myocardial infarction . Ann Emerg Med. 2007; 50(5):520-526.
12.
Boersma E., Mercado N., Poldermans D., Gardien M., Vos J., Simoons MLAcute myocardial infarction. Lancet. 2003; 361(9360):847-858.
13.
Barron HV, Bowlby LJ, Breen T., et al. Use of reperfusion therapy for acute myocardial infarction in the United States: data from the National Registry of Myocardial Infarction 2. Circulation. 1998; 97(12):1150-1156.
14.
Eagle KA, Goodman SG, Avezum A., Budaj A., Sullivan CM, Lopez-Sendon J.Practice variation and missed opportunities for reperfusion in ST-segment-elevation myocardial infarction: findings from the Global Registry of Acute Coronary Events (GRACE). Lancet. 2002;359(9304):373-377.
15.
Ribichini F. , Ferrero V., Wijns W.Reperfusion treatment of ST elevation acute myocardial infarction. Prog Cardiovasc Dis. 2004;47(2):131-157.
16.
Kleinschmidt K., Brady WJAcute coronary syndromes: an evidence based review and outcome-optimizing guidelines for patients with and without procedural coronary intervention (PCI). Part III: fibrinolytic therapy, procedural coronary intervention, multi-modal approaches, and medical prophylaxis with low molecular weight heparins. Hospital Medicine Consensus Reports. Atlanta, GA: American Health Consultants;2001.
17.
Brodie BR, Hansen C., Stuckey TD, et al. Door-to-balloon time with primary percutaneous coronary intervention for acute myocardial infarction impacts late cardiac mortality in high-risk patients and patients presenting early after the onset of symptoms. J Am Coll Cardiol. 2006;47(2):289-295.
18.
Berger PB, Ellis SG, Holmes DR Jr, et al. Relationship between delay in performing direct coronary angioplasty and early clinical outcome in patients with acute myocardial infarction: results from the Global Use of Strategies to Open Occluded Arteries in Acute Coronary Syndromes (GUSTO-IIb) trial. Circulation. 1999; 100(1):14-20.
19.
An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. The GUSTO Investigators. N Engl J Med. 1993;329(10):673-682.
20.
Boersma E., Maas AC, Deckers JW, Simoons MLEarly thrombolytic treatment in acute myocardial infarction: reappraisal of the golden hour. Lancet. 1996;348(9030):771-775.
21.
De Luca G., Suryapranata H., Ottervanger JP, Antman EMTime delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts . Circulation. 2004;109(10):1223-1225.
22.
Rogers WJ, Canto JG, Lambrew CT, et al. Temporal trends in the treatment of over 1.5 million patients with myocardial infarction in the US from 1990 through 1999: the National Registry of Myocardial Infarction 1, 2 and 3. J Am Coll Cardiol . 2000; 36(7):2056-2063.
23.
Goff DC Jr , Feldman HA, McGovern PG, et al. Prehospital delay in patients hospitalized with heart attack symptoms in the United States: the REACT Trial. Rapid Early Action for Coronary Treatment (REACT) Study Group. Am Heart J. 1999;138(6 pt 1): 1046-1057.
24.
Nallamothu BK, Bates ERPercutaneous coronary intervention versus fibrinolytic therapy in acute myocardial infarction: is timing (almost) everything ? Am J Cardiol. 2003;92(7):824-826.
25.
Nissen SE, Brush JE Jr, Krumholz HMPresident’s page: GAP-D2B: an alliance for quality. J Am Coll Cardiol. 2006;48(9): 1911-1912.
26.
What is D2B?http://www.d2balliance.org/WhatisD2B/D2BCoreStrategies/tabid/145/default.aspx. Accessed March 15, 2007.
27.
Jacoby J., Axelband J., Patterson J., Belletti D., Heller M.Cardiac cath lab activation by the emergency physician without prior consultation decreases door-to-balloon time. J Invasive Cardiol. 2005;17(3):154-155.
28.
Thatcher JL , Gilseth TA, Adlis S.Improved efficiency in acute myocardial infarction care through commitment to emergency department-initiated primary PCI. J Invasive Cardiol. 2003; 15(12):693-698.
29.
Brener SJ, Zeymer U., Adgey AA, et al. Eptifibatide and low-dose tissue plasminogen activator in acute myocardial infarction: the Integrilin and low-dose Thrombolysis in Acute Myocardial Infarction(INTRO AMI) trial. J Am Coll Cardiol. 2002;39(3): 377-386.
