Ethnic minorities exhibit reduction in door-to-balloon time comparable to whites with a newly-implemented emergency
Anthony Al-Dehneh1, Rupen Parikh, Aiman Hamdan
1Department of Cardiology, Seton Hall University, St. Joseph's Regional Medical Center, Paterson, New Jersey 07503, USA.
Insights
Implementing a "Code STEMI" protocol significantly reduced door-to-balloon times for all patients undergoing angioplasty for ST-elevation myocardial infarction (STEMI). This new protocol eliminated ethnic disparities in treatment times and improved outcomes for both white and minority groups.
Area of Science:
- Cardiology
- Health Services Research
Background:
- Ethnic disparities in door-to-balloon (D2B) times for ST-elevation myocardial infarction (STEMI) patients are a documented concern.
- Previous studies indicated longer D2B times for minority patients compared to white patients undergoing angioplasty.
Purpose of the Study:
- To evaluate the impact of a modified emergency protocol on D2B times for STEMI patients.
- To assess ethnic disparities in D2B times, length of stay (LOS), and peak troponin I levels before and after protocol implementation.
Main Methods:
- A retrospective comparison of D2B times was conducted between two groups of STEMI patients.
- The first group (n=51) was treated under a serial activation protocol (SAP) in 2006.
- The second group (n=72) was treated under a new "Code STEMI" concurrent activation protocol in 2007.
Main Results:
- The "Code STEMI" protocol significantly reduced median D2B times for both white and minority patients (from 113 vs. 122 minutes to 74 vs. 78 minutes, respectively; p < 0.0001).
- No significant ethnic disparities were observed in D2B times, peak troponin I levels, or length of stay within either protocol group.
- Both groups showed comparable improvements in D2B times and LOS after the "Code STEMI" protocol implementation.
Conclusions:
- The "Code STEMI" protocol effectively reduced D2B times for all STEMI patients.
- The modified protocol eliminated ethnic disparities in D2B times, LOS, and peak troponin I levels.
- Comparable improvements in key cardiac event outcomes were observed across ethnic groups following protocol changes.
Background:
Studies have shown significant differences in door-to-balloon times (D2B) for ethnic minority patients (minorities) undergoing angioplasty for ST-elevation myocardial infarction (STEMI) compared to white patients (white). In this study, we evaluated the D2B for these groups before and after modification of the emergency protocol for STEMI.
Methods:
We compared D2B for 51 consecutive STEMIs during 2006, (serial activation protocol, SAP) with D2B times for 72 consecutive STEMI patients during 2007 when a "Code STEMI" (concurrent activation) protocol was instituted. Outcomes were D2B times in whites versus minorities, pre- and post-Code-STEMI, length of stay (LOS) and peak troponin I levels.
Results:
The median D2B time in the SAP group was 113 (whites) vs. 122 (minorities) minutes (p = 0.324), as compared to 74 (whites) vs. 78 (minorities) minutes (p = 0.324) in the Code STEMI group. The D2B for both groups was significantly reduced (p < 0.0001) with the use of Code STEMI. The median peak troponin I in the SAP group was 97 ng/mL (whites) vs. 78 ng/mL (minorities) (p = 0.084), as compared to 54 ng/mL (whites) vs. 29 ng/mL (minorities) (p = 0.084) for the Code STEMI group. LOS was 4.88 days (whites) vs. 4.39 days (minorities) (p = 0.84) in the SAP group, as compared to 3.7 days (whites) vs. 3.4 days (minorities) (p = 0.84) for the Code STEMI group, a significant change (p = 0.012) for both groups.
Conclusion:
No ethnic disparity was observed in the mean D2B time, LOS and peak troponin I levels between whites and minorities; both groups demonstrated comparable improvement in all outcomes evaluated.
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