A Campaign to Improve the Timeliness of Primary Percutaneous Coronary Intervention

Krumholz, Harlan M.; Bradley, Elizabeth H.; Nallamothu, Brahmajee K.; Ting, Henry H.; Batchelor, Wayne; Kline–Rogers, Eva; Stern, Amy F.; Byrd, Jason R.; Brush, John E.

doi:10.1016/j.jcin.2007.10.006

Cited by 263 publications

(195 citation statements)

References 24 publications

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“…Patients also need further guidance to use EMS for potential acute coronary syndromes, and EMS personnel should use prehospital transmission of ECGs to receiving hospitals as much as possible. In 2006, the ACC launched an initiative to focus on standardized guidelines to improve in‐hospital reperfusion times 5. Since that launch, D2B times have drastically decreased and sex‐related disparities in D2B times have improved 27.…”

Section: Discussionmentioning

confidence: 99%

“…In the past, there had been a focus on achieving a door‐to‐balloon (D2B) time ≤90 minutes, ie, time of hospital arrival to primary PCI 3. D2B time has proven to be a fair metric, and strategies such as prehospital transmission of ECGs have been designed around meeting such a benchmark with moderate success 4, 5, 6, 7. Studies have shown that reducing D2B times beyond this 90‐minute benchmark has not resulted in decreased mortality; notably, mortality from STEMI has plateaued with further reductions in D2B.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Sex and Contact‐to‐Device Time on Clinical Outcomes in Acute ST‐Segment Elevation Myocardial Infarction—Findings From the National Cardiovascular Data Registry

Roswell

Kunkes

Chen

et al. 2017

JAHA

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BackgroundEmergent myocardial reperfusion via primary percutaneous coronary intervention is optimal care for patients presenting with ST‐segment elevation myocardial infarction (STEMI). Delays in such interventions are associated with increases in mortality. With the shift in focus to contact‐to‐device (C2D) time as a new perfusion metric, this study was designed to examine how sex affects C2D time and mortality in STEMI patients.Methods and ResultsClinical data on male and female STEMI patients were extracted and analyzed from the National Cardiovascular Data Registry from July 1, 2008 to December 31, 2014. A total of 102 515 patients were included in the final analytic cohort. The median C2D time in female patients with STEMI was delayed when compared to male patients (80 [65–97] versus 75 [61–90] minutes; P<0.001). The unadjusted mortality was higher in female patients when compared to male patients with STEMI (4.1% versus 2.0%; P<0.001). For every 5‐minute increase in C2D time, the adjusted odds ratio for mortality was 1.04 (95% CI, 1.03–1.06) for female patients with STEMI and 1.07 (95% CI, 1.06–1.09) for male patients (P for sex by C2D interaction=0.003).ConclusionsTo date, this is the largest analysis of STEMI patients that measures the impact of the new recommended C2D reperfusion metric on in‐hospital mortality. Female STEMI patients have longer C2D times and increased mortality. The disparity can be improved and survival can increase in this high‐risk patient cohort by decreasing systems issues that cause increased reperfusion times in female STEMI patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of Sex and Contact‐to‐Device Time on Clinical Outcomes in Acute ST‐Segment Elevation Myocardial Infarction—Findings From the National Cardiovascular Data Registry

Roswell

Kunkes

Chen

et al. 2017

JAHA

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“…42 These early initiatives have been found to be effective with significant improvements in outcomes in patients presenting with STEMI. 43 They present us with a pragmatic approach to reducing CTN time in ACS and eventually to potentially closing the gap between rural and metropolitan populations' access to reperfusion.…”

Section: Approaches To Improving Outcomesmentioning

confidence: 99%

Acute coronary syndrome in Australia

Nadel¹,

Hewitt²,

Horton³

2017

AMJ

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“…Dissemination research requires developing learning networks to engage stakeholders and beneficiaries broadly. For example, the Door-to-Balloon Alliance for Quality spread interventions to improve door-to-balloon time to over 1 200 hospitals in the United States through a learning network (Krumholz et al, 2008).…”

Section: Domains Of Outcomes Researchmentioning

confidence: 99%

Outcomes research: science and action

Ting

Xiang

Wang

2013

J. Zhejiang Univ. Sci. B

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Outcomes research, which investigates the outcomes of health care practices, is intended to provide scientific evidence for clinical decision making and health care. This paper elucidates the goal and domains of outcomes research. Also it shows the potential and promise of outcomes research to provide a methodology to uncover what to do and how to do it, and enable the health care profession to achieve the right care, for the right patient, at the right time, the first time, every time, nothing more, and nothing less. Clinical caseA 56 year-old male smoker presented to a hospital emergency department, having suffered 3 h of severe chest pain. Physical exam showed a heart rate of 90 beats/min, blood pressure of 90/60 mmHg, and bibasilar rales. An electrocardiogram performed within 10 min of arrival demonstrated a 2-mm ST-elevation in leads V 1 -V 4 (Fig. 1). The patient was treated with 325 mg of aspirin, 600 mg of clopidogrel, and 4 000 U of heparin, and underwent primary percutaneous coronary intervention using right radial artery access. Following aspiration thrombectomy, a drug-eluting stent was placed in the left anterior descending artery, restoring normal blood flow. The door-to-balloon time was 70 min. Echocardiography showed a preserved left ventricular ejection fraction of 60% with only mild anterior-apical hypokinesis. He was started on 50 mg of metoprolol twice daily, 40 mg of atorvastatin daily, 81 mg of aspirin daily, and 75 mg of clopidogrel daily, and discharged from hospital on Day 3. Was this high-quality patient care?The care provided in the emergency department, cardiac catheterization lab, and coronary care unit was appropriate and excellent. However, despite rapid diagnosis and treatment for this patient with ST-elevation myocardial infarction, what were the long-term patient outcomes at 30 d, 6 months, and 1 year? While long-term survival free from recurrent major adverse cardiovascular events depends on the door-to-balloon time and type of drug-eluting stent, it also depends on the patient's ability to adhere to medication schedules, to follow up with his or her physician, to change his lifestyle, including smoking cessation, diet, and exercise, and to access and pay for health care services and secondary prevention.

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A Campaign to Improve the Timeliness of Primary Percutaneous Coronary Intervention

Abstract: The design of the D2B: An Alliance for Quality, a novel campaign to improve D2B time, is described.

Cited by 263 publications

References 24 publications

Impact of Sex and Contact‐to‐Device Time on Clinical Outcomes in Acute ST‐Segment Elevation Myocardial Infarction—Findings From the National Cardiovascular Data Registry

Impact of Sex and Contact‐to‐Device Time on Clinical Outcomes in Acute ST‐Segment Elevation Myocardial Infarction—Findings From the National Cardiovascular Data Registry

Acute coronary syndrome in Australia

Outcomes research: science and action

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