Related Experiment Video
Updated: Jun 2, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
"Code STEMI" protocol helps in achieving reduced door-to-balloon times in patients presenting with acute ST-segment
Sharad Bajaj1, Rupen Parikh, Nishant Gupta
1Department of Internal Medicine, St. Joseph's Regional Medical Center, Paterson, New Jersey 07503, USA.
Insights
The "Code STEMI" protocol significantly reduced door-to-balloon times for ST-elevation myocardial infarction patients during off-hours, improving care quality. This initiative decreased median times by 52 minutes, with lower troponin levels observed.
Area of Science:
- Cardiology
- Emergency Medicine
- Healthcare Quality Improvement
Background:
- Door-to-balloon (D2B) time is a critical metric for assessing acute ST-segment elevation myocardial infarction (STEMI) care quality.
- Optimal primary percutaneous intervention for STEMI ideally occurs within 90 minutes of hospital arrival.
Purpose of the Study:
- To evaluate the impact of an emergency physician-activated "Code STEMI" protocol on D2B times during off-hours.
- To compare D2B times, component times, cardiac biomarker levels, and mortality rates before and after protocol implementation.
Main Methods:
- A retrospective study comparing 27 STEMI patients during off-hours pre-protocol (2006) with 60 STEMI patients during off-hours post-protocol implementation (2007-2008).
- Primary endpoint was median D2B time; secondary endpoints included ECG-to-catheterization lab time, peak troponin-I, peak creatine kinase, and in-hospital and 6/12-month all-cause mortality.
Main Results:
- Median D2B time decreased by 52 minutes (from pre-protocol to 77 minutes post-protocol; p=0.0001).
- ECG-to-catheterization laboratory time reduced by 16 minutes.
- Median peak troponin-I levels significantly decreased post-protocol (p < 0.002).
- No significant differences in all-cause mortality were observed between groups.
Conclusions:
- The "Code STEMI" protocol implementation significantly reduced D2B times for STEMI patients during off-hours.
- The protocol improved a key quality indicator for STEMI care during periods of reduced staffing.
Background:
Door-to-balloon (D2B) time is conceived as a crucial parameter for evaluating the quality of acute ST-segment elevation myocardial infarction (STEMI) care. Ideally, primary percutaneous intervention should be performed within 90 min of hospital arrival.
Objectives:
We sought to determine the impact of emergency physician-activated "Code STEMI" protocol on door-to-balloon times during off-hours.
Methods:
Patients were divided into two study groups: one group consisted of 27 STEMI patients who presented during off-hours in the pre-Code STEMI period (January to December 2006) and the second group consisted of 60 STEMI patients admitted during off-hours when Code STEMI was fully operational (January 2007 to December 2008). The primary objective was to compare median D2B times in both the study groups. Secondary parameters of interest included the individual components of D2B time, peak serum troponin levels, peak creatine kinase total levels, all-cause in-hospital mortality, 6-month all-cause mortality, and 12-month all-cause mortality.
Results:
With the implementation of "Code STEMI" protocol, the median D2B time during off-hours dropped to 77 min (interquartile range [IQR] 67-95), representing a 52-min improvement (p = 0.0001). ECG-to-catheterization laboratory time demonstrated absolute reduction of 16 min. Median peak troponin-I levels dropped from 62 ng/mL (IQR 23-142) to 25 ng/mL (IQR 7-43; p < 0.002). No statistically significant differences were perceived in all-cause mortality among the study groups.
Conclusions:
Implementation of "Code STEMI" protocol at our institution significantly reduced D2B times for STEMI during off-hours.
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
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management