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Door-to-balloon time in acute ST segment elevation myocardial infarction--further experience

David J Fergusson1, Christian Spies, Robert A Hong

  • 1Department of Cardiovascular Disease, The Queen's Medical Center, Honolulu, HI, USA. dfergusson@queens.org

Hawai'I Journal of Medicine & Public Health : a Journal of Asia Pacific Medicine & Public Health
|November 17, 2012
PubMed

Insights

Achieving rapid reperfusion for ST segment elevation myocardial infarction is crucial. A protocol allowing pre-hospital electrocardiogram transmission significantly reduced Door-to-Balloon times, meeting American College of Cardiology goals in 97% of cases.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Health Systems Improvement

Background:

  • Early coronary reperfusion is the standard treatment for ST-elevation myocardial infarction (STEMI).
  • Minimizing delays in achieving coronary artery recanalization is critical for patient outcomes.
  • Established protocols aim to streamline the treatment pathway for STEMI patients.

Purpose of the Study:

  • To analyze Door-to-Balloon (D2B) times for STEMI patients over a four-year period.
  • To evaluate the impact of enhanced pre-hospital care on D2B times.
  • To assess compliance with the American College of Cardiology's 90-minute D2B time target.

Main Methods:

  • Analysis of D2B times for Emergency Department patients with STEMI.
  • Implementation of a protocol to reduce treatment delays.
  • Integration of pre-hospital 12-lead electrocardiogram (EKG) transmission by ambulance personnel.
  • Comparison of achieved D2B times against the 90-minute benchmark.

Main Results:

  • Initial improvement in D2B times was observed after protocol implementation.
  • 100% compliance with the 90-minute D2B goal was achieved within the first year.
  • Sustained high compliance, reaching 97%, was maintained throughout the remaining study period.

Conclusions:

  • Enhanced pre-hospital capabilities, including EKG transmission, significantly improve D2B times for STEMI.
  • Protocols focused on reducing delays are effective in meeting critical treatment benchmarks.
  • High compliance rates demonstrate the successful implementation of a streamlined STEMI treatment pathway.

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