Door-to-Balloon Times Under 90 Min Can Be Routinely Achieved for Patients Transferred for ST-Segment Elevation Myocardial Infarction Percutaneous Coronary Intervention in a Rural Setting

• Published in: Journal of the American College of Cardiology Vol. 57; no. 3; pp. 272 - 279
• Main Authors: Blankenship, James C., MD, Scott, Thomas D., DO, Skelding, Kimberly A., MD, Haldis, Thomas A., DO, Tompkins-Weber, Karen, RN, Sledgen, Marie Y., RN, Donegan, Michael A., DO, Buckley, Jeremy W., MD, Sartorius, Jennifer A., MS, Hodgson, John McB., MD, Berger, Peter B., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 18-01-2011; Elsevier; Elsevier Limited
• Subjects: Aged; Angioplasty, Balloon, Coronary - methods; Angioplasty, Balloon, Coronary - mortality; Angioplasty, Balloon, Coronary - standards; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular; Coronary heart disease; Diseases of the cardiovascular system; Female; Heart; Heart attacks; Helicopters; Hospital Mortality - trends; Hospitalization; Hospitals; Hospitals, Rural - standards; Humans; Internal Medicine; Intubation; Laboratories; Male; Medical sciences; Middle Aged; myocardial infarction; Myocardial Infarction - diagnosis; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Myocarditis. Cardiomyopathies; Patient Transfer - methods; Patient Transfer - standards; Physicians; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); reperfusion time; Retrospective Studies; STEMI systems; stents; Time Factors; United States > US; Pennsylvania; percutaneous coronary intervention; electrocardiography/electrocardiogram; stents; myocardial infarction; PCI; ECG; STEMI; reperfusion time; ST-segment elevation myocardial infarction; STEMI systems; Human; Myocardial infarction; Atherectomy; Rural environment; Angioplasty; Coronary artery; Setting; Instrumentation therapy; Cardiovascular disease; Patient; Time; Coronary heart disease; Myocardial disease; Stent; Percutaneous route; ST elevation; Sounding balloon; Rural area; Circulatory system; Cardiology
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2010.06.056

Objectives The purpose of this study was to demonstrate the feasibility of routine transfer of ST-segment elevation myocardial infarction (STEMI) patients to achieve percutaneous coronary intervention (PCI) in less than 90 min from presentation. Background Many PCI hospitals have achieved routine door-to-balloon times under 90 min for patients with STEMI presenting directly to the hospital. However, few patients transferred from a non-PCI center undergo PCI within 90 min of presentation. Methods Our rural PCI hospital implemented a program in 2005 for rapid triage, transfer, and treatment of STEMI patients and made additional improvements in 2006 and 2007. Intervals between milestones in the STEMI triage/transfer/treatment process were assessed before and after implementation of the program. Results During the 5-year study period, 676 patients with 687 STEMIs were transferred from 19 community hospitals and underwent PCI. Median door-to-balloon time decreased from 189 min to 88 min (p < 0.001). The time intervals reflecting efficiency of the referring hospitals, transfer services, and PCI hospital all significantly improved. In 2008, median door-to-balloon times were <90 min for 6 of the 7 most frequently referring hospitals. Delays during off-hours presentation in 2004 were abolished after the program was implemented in 2005. In-hospital mortality decreased from 6% before to 3% after implementation of the program. In multivariate modeling, presentation before initiation of the STEMI program predicted increased risk of in-hospital mortality (odds ratio: 3.74, 95% confidence interval: 1.22 to 11.51, p = 0.021). Conclusions A program of rapid triage, transfer, and treatment of STEMI patients presenting to non-PCI hospitals can reduce in-hospital mortality and produce progressive improvements in door-to-balloon time such that median door-to-balloon times under 90 min are feasible.