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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.
Insights
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.
Background:
Percutaneous coronary intervention is the preferred treatment for acute ST-segment elevation myocardial infarction (STEMI), and shorter door-to-balloon time (D2B) is associated with lower mortality. We implemented a catheterization laboratory within the emergency department (ED) as a novel strategy to reduce D2B.
Objectives:
The purpose of this paper was to compare D2B and mortality in STEMI patients presenting to ED vs standard catheterization labs at a community hospital.
Methods:
We prospectively reviewed consecutive patients presenting with STEMI to our institution between 1998 and 2011 and treated with primary percutaneous coronary intervention. The primary endpoints were D2B and time to death. A multivariable linear regression model was used to assess the relationship between catheterization lab location and D2B. The relationship between D2B and mortality was examined using a Cox proportional hazards model.
Results:
We included 1,053 STEMI patients (553 in ED vs 500 in standard catheterization labs). Both groups had similar age, sex, race, diabetes, left main disease, and Killip class on presentation. Standard catheterization lab patients were more likely to have left ventricular ejection fraction <40% (11% vs 6.5%). D2B was shorter in ED vs standard cath lab patients (54 vs 83 minutes, P < 0.001). ED catheterization lab patients were more likely to have <30-minute D2B (17% vs <1%, P < 0.001). After covariate adjustment, ED catheterization lab patients had lower 30-day (adjusted hazard ratio [adj HR]: 0.54, 95% confidence interval [CI] 0.29-0.99), 1-year (adj HR: 0.58, 95% CI: 0.37-0.91), and 10-year mortality (adj HR: 0.39, 95% CI: 0.29-0.53) than standard catheterization lab patients.
Conclusions:
Implementation of an ED catheterization lab is a feasible strategy which may reduce D2B and STEMI mortality.
