Door-to-balloon time for primary percutaneous coronary intervention: how does Northern West Virginia compare?

The National Registry of Myocardial Infarction reported that only 4% of patients transferred for primary percutaneous coronary intervention (PCI) achieved the recommendation of a door-to-balloon time of < 90 min.

To see if the American College of Cardiologists/American Heart Association (ACC/AHA) guideline of < 90 min door-to-balloon time for primary PCI is being met in a rural area of West Virginia, and compare to the national average.

A chart review of all cases of emergent primary PCI for ST-segment elevation myocardial infarction (STEMI) performed in the northern panhandle of West Virginia.

The northern panhandle of West Virginia has seven hospitals, of which only one has the capability to perform primary PCI. Two hundred two patients underwent emergent PCI for STEMI from January 1, 2009-September 11, 2010. For each patient, the initial presenting time, arrival time to the PCI hospital, and start of PCI time were recorded. Eight patients were eliminated from the study for not having an initial presenting time. Of the remaining 194 patients, 89 were transferred for primary PCI. Forty-nine patients met the ACC/AHA recommendation of < 90 min door-to-balloon time. The average door-to-balloon time for patients transferred for primary PCI was 104.9 min (Standard Deviation [STD]. 58.2219, 95% confidence interval 92.85-117.04).

Fifty-five percent of patients transferred for primary PCI in the northern panhandle of West Virginia met the recommended guidelines. This is an improvement on the national average of 4%.