Improving Door-to-Balloon Time for Patients With Acute ST-Elevation Myocardial Infarction: A Controlled Clinical
Peyman Namdar1, Leili YekeFallah2, Fatemeh Jalalian3
1Emergency medicine specialist, Assistant Professor, Department of Emergency Medicine, Metabolic Disease Research Center, Qazvin University of Medical Science, Qazvin, Iran.
Insights
Implementing a ST-elevation myocardial infarction (STEMI) code significantly reduced door-to-balloon times for heart attack patients. This rapid intervention improves patient outcomes and emergency department efficiency.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Services Research
Background:
- Timely reperfusion is critical for ST-elevation myocardial infarction (STEMI) patients.
- Current guidelines emphasize rapid angioplasty within 90 minutes to restore blood flow.
- Optimizing treatment pathways is essential for improving patient survival and reducing complications.
Purpose of the Study:
- To evaluate the impact of implementing a STEMI code on door-to-balloon time.
- To assess the effectiveness of a standardized STEMI protocol in a clinical setting.
- To determine if a STEMI code improves efficiency in treating acute myocardial infarction.
Main Methods:
- A clinical trial involving 58 STEMI patients was conducted.
- Patients were divided into control and intervention groups.
- The intervention group utilized a "STEMI code" activated by emergency physicians for confirmed cases.
Main Results:
- The mean door-to-balloon time was significantly reduced in the intervention group (79.3 ± 27.4 minutes) compared to the control group (113.5 ± 43.6 minutes) (P=0.001).
- Reductions in cardiac catheterization laboratory (Cath lab) time and balloon inflation time were also statistically significant (P=0.008).
- The STEMI code minimized parallel work and time wastage during acute myocardial infarction treatment.
Conclusions:
- Implementation of the STEMI code is effective in reducing door-to-balloon time for STEMI patients.
- Shorter treatment times improve emergency department workflow and bed occupancy rates.
- This protocol facilitates timely admission for a greater number of patients.
Abstract:
According to the latest guidelines, the best intervention to restore blood flow through occluded coronary arteries is angioplasty at a time less than 90 minutes. Thereby, the present study was conducted to determine the impact of implementing ST-elevation myocardial infarction (STEMI) code on door-to-balloon time in patients with ST-segment elevation myocardial infarction. This clinical trial was conducted in 2019 at Booali Sina heart center hospital in Qazvin, Iran, in 2019. Fifty-eight patients with STEMI were purposively and consecutively enrolled in the study. Patients were then divided into control and intervention groups, based on their referral period. In both groups, patients were observed since their Arrived by emergency medical services to emergency department until inflating the balloon in the occluded coronary artery, and the intended times were recorded by the researchers. For Participants in the intervention group the "STEMI code" was designed and activated by an emergency physician once there is a patient experiencing a chest pain and early confirmed as a myocardial infarction. The SPSS program (v. 16) was used for data analysis at a significance level of less than 0.05. The difference in the door-to-balloon mean time in both control (113.5 ± 43.6 minutes) and intervention (79.3 ± 27.4 minutes) groups, was statistically significant (P = 0.001). Regarding other parameters, the reduction in the mean between Cath lab time (26.2 ± 18.2 minutes) and balloon time (15.5 ± 7.8 minutes) was also statistically significant (P = 0.008). In this study, implementation of the "STEMI code" could greatly prevent parallel work and squandering time while treating patients with acute myocardial infarction. As the door-to-balloon time gets shorter, the bed occupancy rate in the emergency department had reduced which in turn allowed more patients to be admitted.
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