Data feedback reduces door-to-balloon time in patients with ST-elevation myocardial infarction undergoing primary
Jeng-Feng Lin1, Shun-Yi Hsu, Semon Wu
1Department of Cardiology, Buddhist Tzu-Chi Hospital, Taipei Branch, 289 Jianguo Road, Xindian City, Taipei, 231, Taiwan.
Insights
Implementing data feedback significantly improved door-to-balloon times for ST-elevation myocardial infarction patients receiving primary percutaneous coronary intervention. This approach is a key strategy for reducing treatment delays and achieving guideline goals.
Area of Science:
- Cardiology
- Health Services Research
Background:
- Current guidelines recommend door-to-balloon (D2B) times under 90 minutes for primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI).
- Achieving this goal is critical for optimal patient outcomes.
Purpose of the Study:
- To prospectively evaluate the impact of data feedback on D2B times and its components in primary PCI.
- To identify factors influencing D2B time adherence to guidelines.
Main Methods:
- A prospective study enrolled 116 STEMI patients undergoing primary PCI.
- Data feedback was implemented mid-study, comparing 56 patients before and 60 after its introduction.
- Multivariable analyses identified predictors of achieving D2B time < 90 minutes.
Main Results:
- The proportion of patients treated within 90 minutes increased from 26.8% to 55.0% (p=0.002) after data feedback.
- Median D2B time decreased from 112 to 87 minutes (p<0.001).
- Significant reductions were observed in door-to-ECG, consult-to-cardiologist, and puncture-to-balloon times.
Conclusions:
- Data feedback to emergency department and catheterization laboratory staff effectively reduces D2B times in primary PCI.
- This intervention is a valuable first step for hospitals aiming to meet the <90 minute D2B time goal.
Abstract:
Current guidelines recommend a goal of door-to-balloon (D2B) time < 90 min for patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). We aim to prospectively determine the effect of data feedback on D2B time and its seven individual components in primary PCI. From December 7, 2007, to June 2, 2009, 116 consecutive patients with STEMI who received PCI within 12 h of symptom onset were enrolled, including 56 patients before and 60 patients after the implementation of data feedback on July 28, 2008. The proportion of patients treated within 90 min increased from 26.8 to 55.0% (p = 0.002). On multivariable analyses, data feedback (OR 5.3, p = 0.003), known coronary artery disease (OR 5.6, p = 0.043), regular hours presentation (OR 3.3, p = 0.048), and arrival by transfer (OR 14.0, p = 0.003) were independent predictors of a D2B time less than 90 min. Median D2B time decreased from 112 min before data feedback to 87 min after data feedback (p < 0.001). The most significant decrease occurred in median door-to-ECG (11 vs. 3 min, p < 0.001), consult-to-cardiologist (5 vs. 3 min, p < 0.001), and puncture-to-balloon (21 vs. 17 min, p = 0.004) time. Data feedback to the emergency department and catheterization laboratory staff decreases D2B time in primary PCI. This simple approach may be the best first step to decrease D2B time in hospitals that are still striving to achieve the goal of D2B time < 90 min.
