Emergency Department Activation of an Interventional Cardiology Team Reduces Door-to-Balloon Times in ST-Segment-Elevation Myocardial Infarction

Background: This study aimed to investigate the relationship between the experience level of physicians who initially make a clinical diagnosis of patients with ST segment elevation myocardial infarction in the emergency department and door-to-balloon time (DBT). Material and methods: Between January and December 2018, the research group was selected randomly among 522 patients with ST elevation myocardial infarction who were immediately treated in the catheter laboratory. Angiography images were monitored from the patients’ records in the catheter laboratory. The time of admission to the emergency room was obtained using the hospital registration system. The experience level of physicians who initially clinically diagnosed patients in the emergency department was divided into three groups: medical practitioner (who did not receive emergency training), assistant physician (undergoing emergency medicine training), and emergency medicine specialist. Results: The study included 522 patients who underwent primary percutaneous intervention due to ST segment elevation myocardial infarction. The mean age was lower, and cardiogenic shock and mortality rates were lower in the group with DBT<60 /min compared with the group with DBT>60/min. In the expert group, the mean DBT was lower, but the cardiogenic shock and mortality rates were higher (p<0.05). Conclusions: The duration of DBT decreases as the experience level of the emergency physician increases, but randomization is required to determine its clinical benefit

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Direct Admission of Patients With ST‐Segment–Elevation Myocardial Infarction to the Catheterization Laboratory Shortens Pain‐to‐Balloon and Door‐to‐Balloon Time Intervals but Only the Pain‐to‐Balloon Interval Impacts Short‐ and Long‐Term Mortality

Journal of the American Heart Association ◽

10.1161/jaha.120.018343 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Simcha R. Meisel ◽

Michael Kleiner‐Shochat ◽

Rami Abu‐Fanne ◽

Aaron Frimerman ◽

Asaf Danon ◽

...

Keyword(s):

Myocardial Infarction ◽

Emergency Department ◽

Logistic Regression ◽

St Segment Elevation ◽

Catheterization Laboratory ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Direct Admission ◽

Door To Balloon ◽

The Impact

Background Shortening the pain‐to‐balloon (P2B) and door‐to‐balloon (D2B) intervals in patients with ST‐segment–elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PPCI) is essential in order to limit myocardial damage. We investigated whether direct admission of PPCI‐treated patients with STEMI to the catheterization laboratory, bypassing the emergency department, expedites reperfusion and improves prognosis. Methods and Results Consecutive PPCI‐treated patients with STEMI included in the ACSIS (Acute Coronary Syndrome in Israel Survey), a prospective nationwide multicenter registry, were divided into patients admitted directly or via the emergency department. The impact of the P2B and D2B intervals on mortality was compared between groups by logistic regression and propensity score matching. Of the 4839 PPCI‐treated patients with STEMI, 1174 were admitted directly and 3665 via the emergency department. Respective median P2B and D2B were shorter among the directly admitted patients with STEMI (160 and 35 minutes) compared with those admitted via the emergency department (210 and 75 minutes, P <0.001). Decreased mortality was observed with direct admission at 1 and 2 years and at the end of follow‐up (median 6.4 years, P <0.001). Survival advantage persisted after adjustment by logistic regression and propensity matching. P2B, but not D2B, impacted survival ( P <0.001). Conclusions Direct admission of PPCI‐treated patients with STEMI decreased mortality by shortening P2B and D2B intervals considerably. However, P2B, but not D2B, impacted mortality. It seems that the D2B interval has reached its limit of effect. Thus, all efforts should be extended to shorten P2B by educating the public to activate early the emergency medical services to bypass the emergency department and allow timely PPCI for the best outcome.

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