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Strategies to Reduce the Door-to-Device Time in ST-Elevation Myocardial Infarction Patients

Mojtaba Salarifar1, Javad Askari1, Mohammad Saadat1

  • 1Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

The Journal of Tehran Heart Center
|June 19, 2019
PubMed

Insights

Timely primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) is vital. Interventions targeting dispatch systems and prehospital electrocardiograms significantly reduced door-to-device times, improving STEMI management.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Health Systems Management

Background:

  • Timely primary percutaneous coronary intervention (PPCI) is critical for managing ST-elevation myocardial infarction (STEMI).
  • Prolonged door-to-device (D2D) times can negatively impact patient outcomes.
  • Identifying and addressing factors contributing to delayed D2D times is essential for improving care.

Purpose of the Study:

  • To evaluate factors contributing to and etiologies of prolonged D2D times in STEMI patients.
  • To assess the impact of targeted interventions on D2D times.
  • To compare D2D times before and after implementing improvement strategies.

Main Methods:

  • A retrospective analysis of D2D times for PPCI patients at Tehran Heart Center in 2016 and 2017.
  • Identification of major causes for D2D times exceeding 90 minutes in 2016.
  • Implementation of targeted interventions and feedback in 2017 based on identified causes.
  • Comparison of D2D times between the two study years.

Main Results:

  • Median D2D time decreased from 55 minutes in 2016 to 46 minutes in 2017 (P<0.001).
  • The percentage of patients with D2D time <90 minutes increased from 79.8% to 84.1% (P=0.017).
  • Missed ST-elevation on initial ECG decreased, and associated D2D times also reduced.
  • Increased ambulance arrivals correlated with decreased D2D times.

Conclusions:

  • Targeted interventions, including improving dispatch systems and prehospital ECG use, can significantly reduce D2D times.
  • Regular assessment and feedback are crucial for optimizing D2D times, even with on-site interventionists.
  • System-level improvements in prehospital care enhance the efficiency of STEMI treatment.

Keywords:
AngioplastyMyocardial infarctionST elevation myocardial infarction

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