In-hospital 'CODE STEMI' improves door-to-balloon time in patients undergoing primary percutaneous coronary
Ji Quan Koh1,2, David C Tong1, Rumes Sriamareswaran1
1Department of Cardiology, Peninsula Health, Melbourne, Victoria, Australia.
Insights
Implementing the CODE STEMI notification system significantly reduced door-to-balloon time for ST-segment elevation myocardial infarction (STEMI) patients receiving primary percutaneous coronary intervention (PPCI). This improvement enhances patient outcomes by speeding up critical reperfusion therapy.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Systems Innovation
Background:
- Timely reperfusion is critical for ST-segment elevation myocardial infarction (STEMI) patient outcomes.
- Reducing door-to-balloon time (DTBT) is a key strategy to improve STEMI care.
- Existing strategies aim to optimize the workflow for primary percutaneous coronary intervention (PPCI).
Purpose of the Study:
- To evaluate the impact of the CODE STEMI notification system on DTBT.
- To assess the effectiveness of a hospital-wide public announcement system for STEMI activation.
- To determine if CODE STEMI improves adherence to reperfusion time goals.
Main Methods:
- Prospective analysis of STEMI patients undergoing PPCI before and after CODE STEMI implementation.
- Comparison of median DTBT and the proportion of patients achieving DTBT ≤90 minutes.
- Assessment of secondary outcomes including in-hospital events and 30-day/12-month MACE and readmission rates.
Main Results:
- CODE STEMI significantly reduced median DTBT by 22.1 minutes (67.1 min to 45.0 min, P=0.001).
- A higher proportion of patients achieved the target DTBT ≤90 minutes with CODE STEMI (95.2% vs 73.2%, P=0.007).
- Trends suggested improved in-hospital outcomes, including reduced systolic dysfunction and lower mortality/MACE rates.
Conclusions:
- The CODE STEMI notification system effectively and significantly reduces DTBT in STEMI patients.
- This system represents a novel and successful approach to in-hospital STEMI activation.
- CODE STEMI implementation facilitates faster reperfusion therapy, potentially improving patient prognosis.
Objective:
Reducing time to reperfusion for ST-segment elevation myocardial infarction (STEMI) is essential in improving outcomes. Consequently, numerous strategies have been employed to reduce median door-to-balloon time (DTBT).
Methods:
CODE STEMI is an ED physician-activated STEMI notification system. On activation, an announcement is made over the hospital's public announcement (PA) system. We prospectively analysed all in-hours STEMI patients who had primary percutaneous coronary intervention (PPCI) Pre-CODE STEMI (2014) and after CODE STEMI was implemented (2015). The primary end-points were median DTBT and the proportion of STEMI patients achieving a DTBT ≤90 min. The secondary end-points were in-hospital outcomes, and a composite of major adverse cardiac events (MACE) and hospital readmission rates at 30 days and 12 months.
Results:
There were 41 and 42 patients in Pre-CODE STEMI and CODE STEMI groups respectively. Baseline characteristics were similar. DTBT was significantly reduced by 22.1 min from 67.1 ± 34.9 min Pre-CODE STEMI to 45.0 ± 22.7 min (P = 0.001) in the CODE STEMI group. Door-to-door time (DTDT) was also reduced from 46.3 ± 30.9 min to 29.4 ± 23.3 min (P = 0.006). A greater proportion of CODE STEMI patients achieved the target DTBT ≤90 min (95.2% vs 73.2%, P = 0.007). CODE STEMI patients had less systolic dysfunction measured by a left ventricle ejection fraction of ≤40% (10.0% vs 27.8%, P = 0.07). There were trends to lower in-hospital mortality rates (4.8% vs 9.8%, P = 0.43), MACE at 30 days and 12 months (4.8% vs 9.8%, P = 0.43; 11.9% vs 22.0%, P = 0.25).
Conclusion:
The novel in-hospital in-hours CODE STEMI notification system significantly reduced DTBT in patients undergoing PPCI.
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