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Simultaneous computerised activation of the primary percutaneous coronary intervention pathway reduces out-of-hours

R A Brown1, C Varma2, D L Connolly2

  • 1University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom.

International Journal of Cardiology
|April 2, 2015
PubMed

Insights

Implementing a computerized alert system for out-of-hours primary percutaneous coronary intervention significantly reduced door-to-balloon times. This change improved treatment efficiency but did not impact patient mortality rates.

Area of Science:

  • Cardiology
  • Health Informatics
  • Healthcare Management

Background:

  • A 2009 protocol change in our institution shifted out-of-hours (OOH) primary percutaneous coronary intervention (PPCI) activation from separate calls to a simultaneous computerized alert.
  • This study assesses the impact of this protocol modification on key clinical outcomes.

Purpose of the Study:

  • To evaluate the effect of a simultaneous computerized alert system on door-to-balloon (DTB) times for OOH PPCI.
  • To determine the influence of this protocol change on in-hospital and 1-year mortality.

Main Methods:

  • A retrospective analysis of the Myocardial Ischaemia National Audit Project (MINAP) database was conducted.
  • Patients undergoing OOH PPCI were divided into two groups: pre- (Group 1) and post- (Group 2) implementation of the computerized alert protocol.

Main Results:

  • The study included 793 patients; median DTB time decreased from 92 minutes in Group 1 to 76 minutes in Group 2 (p < 0.0001).
  • The proportion of patients achieving DTB within 90 minutes increased from 48% to 70% (p < 0.0001).
  • Multivariate analysis confirmed computerized alert association with shorter DTB times (OR 2.8, p < 0.0001). In-hospital mortality was 4.1% vs. 5% (p=0.60), and 1-year mortality was 6.1% vs. 9.9% (p=0.09).

Conclusions:

  • Simultaneous computerized activation for OOH PPCI effectively reduced DTB times.
  • The protocol change increased the number of patients meeting target DTB times.
  • The implemented system did not demonstrate a significant impact on in-hospital or 1-year mortality.
Abstract

Keywords:
Door-to-balloon timeOut-of-hoursPrimary percutaneous coronary interventionST-segment elevation myocardial infarction

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