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Emergency Chest Pain Center: A Novel Approach to Reduce Door to Balloon Time
Marwa A Sabe1, Frank J Kaeberlein2, Sharif A Sabe1
1Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
JACC. Advances
|May 14, 2025
Summary
Implementing an emergency department catheterization lab significantly reduced door-to-balloon times for ST-segment elevation myocardial infarction (STEMI) patients. This strategy also led to lower short-term and long-term mortality rates in STEMI patients.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Services Research
Background:
- Percutaneous coronary intervention (PCI) is the primary treatment for ST-segment elevation myocardial infarction (STEMI).
- Shorter door-to-balloon (D2B) times in STEMI patients are directly correlated with reduced mortality.
- A novel strategy involved implementing a catheterization laboratory within the emergency department (ED) to decrease D2B times.
Purpose of the Study:
- To compare D2B times and mortality rates in STEMI patients.
- To evaluate outcomes for patients presenting to an ED catheterization lab versus a standard catheterization lab.
Main Methods:
- Prospective review of 1,053 STEMI patients treated with primary PCI between 1998 and 2011.
- Primary endpoints included D2B time and time to mortality.
- Multivariable regression models assessed the impact of lab location on D2B and mortality.
Main Results:
- ED catheterization lab patients had significantly shorter D2B times (54 vs. 83 minutes, P < 0.001).
- More ED lab patients achieved <30-minute D2B (17% vs. <1%, P < 0.001).
- Adjusted analyses showed lower 30-day, 1-year, and 10-year mortality for ED lab patients.
Conclusions:
- An ED catheterization lab is a feasible and effective strategy for reducing D2B times.
- This approach may significantly decrease mortality in STEMI patients.
- Implementing ED catheterization labs can improve STEMI patient outcomes.
