Treatment delay in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial
Shailja V Parikh1, Joshua A Jacobi, Edwin Chu
1Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Insights
Hospitals often exceed recommended door-to-balloon times for ST-elevation myocardial infarction (STEMI) treatment. Key process analysis reveals patient and hospital factors contributing to delays in primary percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Health Services Research
Background:
- Most US hospitals performing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) exceed recommended door-to-balloon times.
- Identifying and eliminating delays in STEMI treatment is a critical area of interest.
Purpose of the Study:
- To perform a key process analysis of a primary PCI program.
- To assess the contribution of individual time intervals to total ischemic time.
- To identify predictors of delay in STEMI treatment.
Main Methods:
- Key process analysis of a primary PCI program.
- Assessment of time intervals contributing to total ischemic time.
- Identification of predictors for treatment delay in STEMI patients.
Main Results:
- Delays were analyzed in both
- ideal world
- and
- real world
- scenarios.
- Predictors of delay included peripheral vascular disease, self-transportation, symptom presentation timing, female sex, previous stroke, and cardiogenic shock.
- Median symptom onset to first balloon inflation was 272 minutes (ideal) and 297 minutes (real).
Conclusions:
- Key process analysis of primary PCI programs can identify hospital-specific and patient population-specific treatment delays.
- Understanding these unique delays is crucial for optimizing STEMI care pathways.
Background:
Most hospitals that perform primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) in the United States exceed the recommended door-to-balloon time. There is heightened interest in identifying and eliminating factors that introduce delay.
Methods:
We performed a key process analysis of our primary PCI program, assessed the relative contribution of individual time intervals on total ischemic time, and identified predictors of delay.
Results:
Median times and predictors of delay within each time interval were determined for the entire STEMI cohort ("real world") and after exclusion of patients with atypical symptoms and/or presentations of STEMI that resulted in inherent delay in diagnosis and treatment ("ideal world"). Delays in therapy were symptom onset to presentation (120 minutes [interquartile range, IQR, 60-310 minutes, ideal world] and 150 minutes [IQR 60-360 minutes, real world]; predictors of delay were peripheral vascular disease, self-transportation, daytime and weekend presentation); door-to-balloon time (118.5 minutes [IQR 96-141 minutes, ideal world] and 125 minutes [IQR 100-170 minutes, real world]; predictors of delay were female sex, previous stroke, nighttime and weekend presentation, and cardiogenic shock); and symptom onset to first balloon inflation (272 minutes [IQR 187-465 minutes, ideal world] and 297 minutes [IQR 198-560 minutes, real world]; predictors of delay were peripheral vascular disease, weekend presentation, and self-transportation).
Conclusions:
Key process analysis of a primary PCI program identifies treatment delays unique to the hospital and the patient population it serves.
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:27Peripheral Artery Disease III: Interprofessional Care
01:20Angina V: Nursing Management