Reduced door-to-balloon times in acute ST-elevation myocardial infarction patients undergoing primary percutaneous
1Division of Cardiology, Department of Medicine, China Medical University Hospital, Taichung, Taiwan.
Insights
Implementing an on-site cardiology team in the emergency department significantly reduced door-to-balloon times for ST-elevation myocardial infarction patients. This strategy improved timely treatment for primary percutaneous coronary intervention.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Systems Research
Background:
- ST-elevation myocardial infarction (STEMI) treatment requires rapid intervention.
- Primary percutaneous coronary intervention (PCI) is crucial for reducing mortality and morbidity in STEMI.
- Door-to-balloon (D2B) time is a critical metric for effective STEMI care.
Purpose of the Study:
- To evaluate the impact of an on-site cardiology team-based approach in the emergency department (ED).
- To minimize delays in primary PCI for STEMI patients.
- To assess the effect on D2B times and hospitalization costs.
Main Methods:
- A comparative study involving three groups of STEMI patients undergoing primary PCI.
- Pre-on-site group: Conventional care with PCI two blocks from ED (n=147).
- Interim group: PCI in the same building as ED (n=90).
- On-site group: On-site cardiology team in ED (n=146).
Main Results:
- Median D2B time significantly decreased from 107 min (pre-on-site) to 72 min (interim) and 47 min (on-site) (p < 0.001).
- Percentage of patients with D2B time < 90 min increased from 34% to 78% and 96% across the groups (p < 0.001).
- Hospitalization costs were significantly reduced in the on-site and interim groups compared to the pre-on-site group (p = 0.008).
Conclusions:
- An on-site cardiology team-based approach in the ED substantially reduces D2B times for STEMI patients.
- This strategy improves the efficiency of primary PCI delivery.
- The model offers potential for cost savings without impacting in-hospital mortality.
Background:
Primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) significantly reduces mortality and morbidity, particularly when door-to-balloon (D2B) time is < 90 min. We sought to minimize preventable delays by instituting an on-site cardiology team-based approach in the emergency department (ED).
Methods:
The on-site group comprised 146 consecutive patients with STEMI undergoing primary PCI after implementation of the on-site strategy. This new patient care model was compared with the conventional care administered before instituting the on-site cardiology team-based strategy in ED, which included 90 patients (interim group) receiving primary PCI at a catheterization room in the same building as the ED, and 147 patients (pre-on-site group) undergoing primary PCI at a catheterization room two blocks away from the ED.
Results:
Median D2B time decreased from 107 min in the pre-on-site group to 72 min in the interim group, and to 47 min in the on-site group, respectively (p < 0.001). The percentage of D2B times < 90 min increased from 34% to 78% and 96%, respectively among the three groups (p < 0.001). Hospitalization costs were significantly reduced in the on-site and interim vs. pre-on-site groups ($5944, $5999, and $6581, respectively; p = 0.008). In-hospital mortality did not differ significantly among the three groups (4.8%, 2.2%, and 6.1%, respectively; p = 0.387).
Conclusions:
Institution of an on-site cardiology team-based approach in the ED significantly reduces D2B time in STEMI patients eligible for primary PCI.
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