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
In: Journal of the American College of Cardiology, Jg. 57 (2011), Heft 3, S. 272-279
Online
academicJournal
- print, 19 ref
Zugriff:
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.
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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
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Autor/in / Beteiligte Person: | BLANKENSHIP, James C ; SCOTT, Thomas D ; BERGER, Peter B ; SKELDING, Kimberly A ; HALDIS, Thomas A ; TOMPKINS-WEBER, Karen ; SLEDGEN, Marie Y ; DONEGAN, Michael A ; BUCKLEY, Jeremy W ; SARTORIUS, Jennifer A ; HODGSON, John McB |
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Zeitschrift: | Journal of the American College of Cardiology, Jg. 57 (2011), Heft 3, S. 272-279 |
Veröffentlichung: | New York, NY: Elsevier, 2011 |
Medientyp: | academicJournal |
Umfang: | print, 19 ref |
ISSN: | 0735-1097 (print) |
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