Primary percutaneous coronary intervention for ST elevation myocardial infarction: performance with focus on
Gary S H Cheung1, K L Tsui, C C Lau
1Department of Medicine, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong. garycsh@hotmail.com
Insights
Implementing a new management program significantly reduced door-to-treatment times for ST elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. This improvement highlights the effectiveness of organized clinical pathways in delivering timely reperfusion therapy.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- ST elevation myocardial infarction (STEMI) requires rapid reperfusion therapy.
- Primary percutaneous coronary intervention (PCI) is the preferred treatment for STEMI.
- Door-to-treatment time is a critical metric for STEMI management.
Purpose of the Study:
- To evaluate the impact of a new management program on door-to-treatment times for primary PCI in STEMI patients.
- To assess the performance of a primary PCI program in a regional hospital setting.
Main Methods:
- Retrospective study of STEMI patients undergoing primary PCI.
- Data collected from January 2002 to December 2007.
- Analysis focused on door-to-balloon times before and after November 2003.
Main Results:
- A total of 209 STEMI patients underwent primary PCI.
- The mean door-to-balloon time decreased from 146 to 116 minutes after program implementation (P=0.047).
- Common delays included diagnostic delays (28%) and Cath Lab occupancy (20%).
Conclusions:
- The primary PCI program demonstrated satisfactory performance in providing timely reperfusion for STEMI.
- A systematic clinical pathway is essential for effective primary PCI services.
- Enhanced public and provider awareness is needed to improve STEMI outcomes.
Objective:
To review primary percutaneous coronary interventions performed for patients with ST elevation myocardial infarction with a focus on door-to-treatment time, especially after introduction of a new management programme in November 2003.
Design:
Retrospective study.
Setting:
Regional hospital, Hong Kong.
Patients:
All patients with ST elevation myocardial infarction who underwent primary percutaneous coronary intervention in our hospital from January 2002 to December 2007.
Results:
In all, 209 patients with ST elevation myocardial infarction had primary percutaneous coronary interventions between January 2002 and December 2007; 140 of them were admitted within office hours, 125 of whom came directly from Accident and Emergency Department. The mean door-to-balloon time of these patients was 115 minutes, and in 41% the time was less than 90 minutes (as recommended by the American College of Cardiology/American Heart Association guidelines). Since introduction of the new programme, the mean door-to-balloon time has diminished significantly, from 146 to 116 minutes (P=0.047). Delay in diagnosis (28%) and Cardiac Catheterization Laboratory being occupied (20%) were the two most common reasons for prolonged door-to-balloon times.
Conclusion:
We achieved satisfactory performance in our primary percutaneous coronary intervention programme, providing timely reperfusion therapy for patients with ST elevation myocardial infarction. A well-organised and systematic clinical pathway is a prerequisite for a centre that provides a timely and effective primary percutaneous coronary intervention service for patients with ST elevation myocardial infarction. Better public education and greater awareness on the part of medical service providers are needed, so as to facilitate urgent revascularisation and improve outcomes in patients with ST elevation myocardial infarction.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:27Coronary Artery Disease V: Interprofessional Care
01:28Cardiac Catheterization I: Pre-Procedure Overview