Reduction of delays in primary percutaneous coronary intervention
Benoit Daneault1, Doan Hoa Do, Andrée Maltais
1Department of Medicine, Sherbrooke University, Sherbrooke, Québec, Canada.
Insights
Simple interventions significantly reduced door-to-balloon time for primary percutaneous coronary intervention (PPCI) in ST-elevation myocardial infarction patients. This improvement in timely treatment was associated with low 30-day mortality rates.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- Acute myocardial infarction (AMI) is a critical health concern.
- Primary percutaneous coronary intervention (PPCI) is a superior treatment for ST-elevation myocardial infarction (STEMI) when performed promptly.
- Delays in PPCI are linked to increased patient mortality.
Purpose of the Study:
- To assess the effectiveness of simple interventions in reducing door-to-balloon (D2B) time for PPCI.
- To evaluate the impact of these interventions on 30-day mortality in STEMI patients.
Main Methods:
- A prospective registry was utilized to track delays and mortality.
- Interventions, including annual feedback and suggestions, were implemented to minimize D2B delays.
- D2B times were compared before and after the interventions.
Main Results:
- A total of 1361 PPCIs were performed between 2005 and 2008.
- Median D2B time for transferred patients decreased significantly from 142 to 121 minutes (P < 0.001).
- Median D2B time for directly admitted patients decreased from 87 to 74 minutes (P < 0.001), with 30-day mortality remaining low (5.2% to 3.8%).
Conclusions:
- Inexpensive, simple interventions can substantially decrease PPCI-related delays for both transferred and directly admitted STEMI patients.
- The implemented strategies led to reduced treatment delays without compromising patient outcomes, evidenced by low 30-day mortality.
Background:
Acute myocardial infarction is a major health issue. Primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction was proved to be superior to fibrinolytic therapy in many randomized trials when done in a timely manner. However, PPCI is associated with delays. Studies have shown that greater delay is associated with increased mortality rate. We applied simple interventions to reduce door-to-balloon time. Our study goal was to evaluate the reduction of delays after our interventions and to monitor 30-day mortality.
Methods:
A prospective registry was created to evaluate delays and mortality associated with PPCI. Measures such as annual feedback with suggestions were taken to minimize the delays. Door-to-balloon delays before and after the interventions were compared.
Results:
A total of 1361 primary PCIs were performed from 2005 to 2008. Of these cases, 1071 patients were transferred from community hospitals. The median door-to-balloon time for transferred patients was 142 minutes for 2005, 138 minutes for 2006, 125 minutes for 2007, and 121 minutes for 2008 (P < 0.001 for 2005 vs. 2008). Door-to-balloon time for patients admitted directly to our centre was 87 minutes in 2005, 74.5 minutes in 2006, 73.5 minutes in 2007, and 74.0 minutes in 2008 (P < 0.001 for 2005 vs. 2008). Thirty-day mortality of these consecutive patients is low (5.2% for 2005 and 3.8% for 2008; P = not significant).
Conclusions:
Inexpensive and simple interventions may significantly reduce primary PCI-related delays for transferred cases and patients admitted directly to a centre with PPCI facilities. We also observed a low mortality rate for those consecutive patients.
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