Impact of a rapid access protocol on decreasing door-to-balloon time in acute ST elevation myocardial infarction
Jaelyn M Caudle1, Zoe Piggott, Suzanne Dostaler
1Department of Emergency Medicine, Queen's University, Kingston, Ont. jaelyncaudle@hotmail.com
Insights
A new protocol significantly reduced reperfusion times for ST elevation myocardial infarction (STEMI) patients. Direct transport to the cardiac catheterization lab for percutaneous coronary intervention (PCI) shortened door-to-balloon times, improving emergency cardiac care.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Systems Research
Background:
- Ischemic cardiovascular disease is a leading cause of death in Canada.
- Timely reperfusion is critical for ST elevation myocardial infarction (STEMI) outcomes.
- Delays in diagnosis and treatment access impact percutaneous coronary intervention (PCI) effectiveness.
Purpose of the Study:
- To evaluate the effectiveness of a rapid access to PCI protocol.
- To assess the impact of direct emergency department (ED) to catheterization lab transport on door-to-balloon times for STEMI patients.
Main Methods:
- A quasi-experimental study comparing two 1-year periods before and after protocol implementation.
- Analysis of administrative data for STEMI patients receiving emergent PCI via regional emergency medical services (EMS).
- Primary outcome: door-to-balloon time, analyzed using Mann-Whitney U test and Kaplan-Meier curves.
Main Results:
- Median door-to-balloon time decreased from 87 minutes pre-protocol to 62 minutes post-protocol.
- This reduction was statistically significant (p < 0.001).
- The study included 42 historical controls and 39 patients under the rapid access protocol.
Conclusions:
- Implementation of an EMS protocol for rapid PCI access significantly reduced reperfusion times in STEMI patients.
- The protocol demonstrated effectiveness in improving time-sensitive cardiac interventions.
- This model offers a strategy to optimize emergency cardiac care pathways.
Objective:
Ischemic cardiovascular disease is the leading cause of death in Canada. In ST elevation myocardial infarction (STEMI), time to reperfusion is a key determinant in reducing morbidity and mortality with percutaneous coronary intervention (PCI) being the preferred reperfusion strategy. Where PCI is available, delays to definitive care include times to electrocardiogram (ECG) diagnosis and cardiovascular laboratory access. In 2004, the Cardiac Care Network of Ontario recommended implementation of an emergency department (ED) protocol to reduce reperfusion time by transporting patients with STEMI directly to the nearest catheterization laboratory. The model was implemented in Frontenac County in April 2005. The objective of this study was to assess the effectiveness of a protocol for rapid access to PCI in reducing door-to-balloon times in STEMI.
Methods:
Two 1-year periods before and after implementation of a rapid access to PCI protocol (ending March 2005 and June 2006, respectively) were studied. Administrative databases were used to identify all subjects with STEMI who were transported by regional emergency medical services (EMS) and received emergent PCI. The primary outcome measure was time from ED arrival to first balloon inflation (door-to-balloon time). Times are presented as medians and interquartile ranges (IQRs). Statistical comparisons were made using the Mann-Whitney U test and presented graphically with Kaplan-Meier curves.
Results:
Patients transported under the rapid access protocol (n = 39) were compared with historical controls (n = 42). Median door-to-balloon time was reduced from 87 minutes (IQR 67-108) preprotocol to 62 minutes (IQR 40-80) postprotocol (p < 0.001).
Conclusion:
In our region, implementation of an EMS protocol for rapid access to PCI significantly reduced time to reperfusion for patients with STEMI.
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