Aggressive Measures to Decrease "Door to Balloon" Time and Incidence of Unnecessary Cardiac Catheterization:...

Area of Science:

• Cardiology
• Emergency Medicine
• Quality Improvement

Background:

• Rapid reperfusion therapy is critical for ST-segment elevation myocardial infarction (STEMI).
• Decreasing door to balloon (DTB) time is a key performance metric.
• The impact of aggressive DTB time reduction on diagnostic accuracy and patient outcomes requires evaluation.

Purpose of the Study:

• To assess the effect of an aggressive protocol to shorten DTB time on false-positive STEMI (FP-STEMI) diagnoses.
• To evaluate the impact on in-hospital mortality in patients with presumed STEMI.
• To determine if a quality improvement initiative could maintain short DTB times while improving outcomes.

Main Methods:

• A retrospective analysis of 1031 patients with presumed STEMI undergoing emergent catheterization.
• Comparison of outcomes before and after implementing an aggressive DTB time reduction protocol.
• Assessment of outcomes before and after a quality improvement initiative aimed at maintaining short DTB times.

Main Results:

• The aggressive DTB time protocol significantly reduced median DTB time (76 to 61 minutes).
• This reduction was associated with a significant increase in FP-STEMI incidence (7.7% to 16.5%).
• In-hospital mortality increased significantly in FP-STEMI patients (P=.03) despite a QI initiative maintaining short DTB times and decreasing FP-STEMI mortality.

Conclusions:

• Aggressive DTB time reduction strategies can increase FP-STEMI and associated in-hospital mortality.
• Systematic monitoring is crucial to prevent unnecessary procedures and potential delays in care for critically ill patients.
• Quality improvement initiatives can help maintain short DTB times while mitigating adverse outcomes.