Data feedback reduces door-to-balloon time in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

Abstract

Current guidelines recommend a goal of door-to-balloon (D2B) time < 90 min for patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). We aim to prospectively determine the effect of data feedback on D2B time and its seven individual components in primary PCI. From December 7, 2007, to June 2, 2009, 116 consecutive patients with STEMI who received PCI within 12 h of symptom onset were enrolled, including 56 patients before and 60 patients after the implementation of data feedback on July 28, 2008. The proportion of patients treated within 90 min increased from 26.8 to 55.0% (p = 0.002). On multivariable analyses, data feedback (OR 5.3, p = 0.003), known coronary artery disease (OR 5.6, p = 0.043), regular hours presentation (OR 3.3, p = 0.048), and arrival by transfer (OR 14.0, p = 0.003) were independent predictors of a D2B time less than 90 min. Median D2B time decreased from 112 min before data feedback to 87 min after data feedback (p < 0.001). The most significant decrease occurred in median door-to-ECG (11 vs. 3 min, p < 0.001), consult-to-cardiologist (5 vs. 3 min, p < 0.001), and puncture-to-balloon (21 vs. 17 min, p = 0.004) time. Data feedback to the emergency department and catheterization laboratory staff decreases D2B time in primary PCI. This simple approach may be the best first step to decrease D2B time in hospitals that are still striving to achieve the goal of D2B time < 90 min.

Understanding the stakeholders’ preferences on a mobile application to reduce door to balloon time in the management of ST-elevated myocardial infarction patients – a qualitative study

“…However, with the advent of the digitalization of checklists by electronic-based systems, it was possible to overcome the deficiencies mentioned above but with considerable inconvenience due to reliance on fixed desktops when the patients had to be mobilized for various other diagnostic tests [ 17 ]. Real-time performance feedback to the healthcare team during STEMI activation is associated with a shorter door-to-balloon time [ 18 – 21 ]. Besides, STEMI code activation can be done promptly, without having to progress through routine steps or being blocked by the physical boundaries of the hospital (e.g., the cardiology physician can respond and agree to activate the STEMI code even from outside the hospital).…”

Impact of hypertension on short- and long-term prognoses in patients with ST elevation myocardial infarction and without previously known diabetes

“…Hypertension is well established as a risk factor for the development of atherosclerosis [1][2][3], and for increased incidence of cerebrovascular disease [4] and coronary artery disease [5]. In the INTERHEART study, the strength of the association of hypertension with risk of first myocardial infarction (MI) was greater in women than in men [6].…”

Association between holiday and weekend admissions and mortality outcomes among patients with acute myocardial infarction receiving percutaneous coronary intervention in Taiwan

“…In Taiwan, the health service program with various pre-hospital and in-hospital approaches has been endeavoring to reduce the onset-to-door and door-to-ballon times for these patients 36 – 39 . For example, many hospitals have established a specialized team to rapidly diagnose and treat AMI patients 40 . When needed, these pre-hospital and in-hospital approaches are activated not only on weekdays but also during holidays and weekends.…”