Abstract 15151: The Prevalence of Covid-19 on the Door to Balloon Time in Patients With St-elevation Myocardial Infarction

Background: Patients with ST-elevation myocardial infarction (STEMI) should undergo primary PCI (percutaneous coronary intervention) as a standard of care. However, with the increase in the prevalence of COVID-19, all patients with suspected STEMI should be treated as possible COVID-19 cases. Therefore, more time may be needed to establish an acute MI diagnosis and to perform a COVID-19 status assessment. There has been a paucity of data regarding its influence on the primary PCI procedure. Objective: We sought to evaluate the impact of the prevalence of COVID-19 on the door-to-balloon time and clinical outcome in patient with STEMI. Method: Between January 2019 and May 2020, 157 patients with STEMI underwent primary PCI in 3 Japanese PCI centers. Mean age of patients was 70.4±12.9 years, and 71.6% were male. Right distal radial artery access was used in 110 patients (94.8%). We divided these patients into two groups: a group before the COVID -19 outbreak and another group during the pandemic, and were retrospectively analyzed. The following patients’ baseline characteristics were obtained: door-to-balloon time, duration in the emergency department, finding of CT scan if conducted, peak CK, 30-day mortality rate. Results: We evaluated patients with STEMI who underwent PCI between January 2019 and January 2020 (before the pandemic) and between February 2020 and May 2020 (during the pandemic). The number of patients was 119 before pandemic and 37 during pandemic. Mean door-to-balloon time was 35.8 ± 24.5 min before the pandemic and 41.2 ± 20.8 min after the outbreak (p<0.05). Induration at the emergency department was 22.6 ± 18.6 min before the pandemic and 21.3 ± 13.3 min after the outbreak (p=0.329). CT evaluation was performed before PCI was conducted in 41 patients (34.5%) and 14 patients (37.8%) (p=0.699). The peak CPK was 1956.2 ±2141.9 U/L and 2801.1 ± 2982.5 U/L (P=0.006). There was no significant difference in a 30-day mortality rate (5% vs 0%; P=0.699). Of the 37 patients after the outbreak, no patient underwent PCR examination for COVID-19 virus. Conclusion: The COVID-19 pandemic changed the diagnostic procedure in the emergency department and affected door-to-balloon time in patients with STEMI.

Download Full-text

Evaluation of a regional ST-elevation myocardial infarction primary percutaneous coronary intervention program at the Rouge Valley Health System

10.32920/14639403.v1 ◽

2021 ◽

Author(s):

Pria MD Nippak ◽

Jodie Pritchard ◽

Robin Horodyski ◽

Candace J Ikeda-Douglas ◽

Winston W Isaac

Keyword(s):

Myocardial Infarction ◽

Emergency Department ◽

Percutaneous Coronary Intervention ◽

Primary Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

St Elevation Myocardial Infarction ◽

Primary Pci ◽

Percutaneous Coronary ◽

St Elevation ◽

Door To Balloon

Background ST-elevation myocardial infarction (STEMI) remains the second leading cause of death in Canada. Primary percutaneous coronary intervention (PCI) has been recognized as an effective method for treating STEMI. Improved access to primary PCI can be achieved through the implementation of regional PCI centres, which was the impetus for implementing the PCI program in an east Toronto hospital in 2009. As such, the purpose of this study was to measure the efficacy of this program regional expansion. Methods A retrospective review of 101 patients diagnosed with STEMI from May to Sept 2010 was conducted. The average door-to-balloon time for these STEMI patients was calculated and the door-to-balloon times using different methods of arrival were analyzed. Method of arrival was by one of three ways: paramedic initiated referral; patient walk-ins to PCI centre emergency department; or transfer after walk-in to community hospital emergency department. Results The study found that mean door-to balloon time for PCI was 112.5 minutes. When the door-to-balloon times were compared across the three arrival methods, patients who presented by paramedic-initiated referral had significantly shorter door-to-balloon times, (89.5 minutes) relative to those transferred (120.9 minutes) and those who walked into a PCI centre (126.7 minutes) (p = 0.047). Conclusions The findings suggest that the partnership between the hospital and its EMS partners should be continued, and paramedic initiated referral should be expanded across Canada and EMS systems where feasible, as this level of coverage does not currently exist nationwide. Investments in regional centres of excellence and the creation of EMS partnerships are needed to enhance access to primary PCI.

Download Full-text

Evaluation of a regional ST-elevation myocardial infarction primary percutaneous coronary intervention program at the Rouge Valley Health System

10.32920/14639403 ◽

2021 ◽

Author(s):

Pria MD Nippak ◽

Jodie Pritchard ◽

Robin Horodyski ◽

Candace J Ikeda-Douglas ◽

Winston W Isaac

Keyword(s):

Myocardial Infarction ◽

Emergency Department ◽

Percutaneous Coronary Intervention ◽

Primary Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

St Elevation Myocardial Infarction ◽

Primary Pci ◽

Percutaneous Coronary ◽

St Elevation ◽

Door To Balloon

Download Full-text

Abstract 14181: Impact of Prehospital Mobile Cloud Electrocardiogram Transmission System to Reduce Door to Balloon Time and Onset to Recanalization Time in ST-elevation Myocardial Infarction

Circulation ◽

10.1161/circ.142.suppl_3.14181 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Motoko Kametani ◽

Takashi Unoki ◽

Daisuke Takagi ◽

Yudai Tamura ◽

Tomoko Nakayama ◽

...

Keyword(s):

Myocardial Infarction ◽

Hospital Mortality ◽

Transmission System ◽

St Elevation Myocardial Infarction ◽

Mobile Cloud ◽

Fire Departments ◽

Significant Difference ◽

St Elevation ◽

Door To Balloon ◽

The Impact

Background: Guidelines strongly recommend patients with ST-elevation myocardial infarction (STEMI) receive timely mechanical reperfusion, defined as door-to-balloon time (DTBT) ≤90 minutes. Objective: To evaluate the impact of the prehospital mobile cloud ECG transmission system (C-ECG) on DTBT and mortality in patients with STEMI. Methods: On June 2018, eight mobile C-ECG systems (SCUNA®, MEHERGEN GROUP) were implemented into the Uki and Kamimashiki fire departments in Kumamoto, Japan. Within two years, 428 ECGs of patients complaining of chest pain, difficulty in breathing and any other symptom that the emergency staff deemed necessary were transmitted to our hospital. 119 patients were diagnosed with ACS, 93 received emergency CAG and 69 were diagnosed with STEMI. After excluding eight patients with onset to arrival over 24 hours, a total of 137 consecutive STEMI patients received emergency PCI during the study period. Among them, 68 received PCI during the pre-C-ECG period (Pre: from June 2016 to May 2018), whereas 69 were received during the post-C-ECG period (Post: June 2018 to May 2020). We compared the DTBT, Onset to Recanalization time (OTRT), and in-hospital mortality between the two periods. Results: There was no significant difference in age, gender, Killip classification, and number of diseased coronary lesion between the two periods. The door to Cath-Lab time (DTCT) and DTBT were significantly shorter in the post-C-ECG period compared to the pre-C-ECG period (Pre: 34 min [IQR; 23-44] vs. Post: 24 min [IQR; 18-38]; P=0.01, Pre: 66 min [IQR; 48-80] vs. Post: 49 min [IQR; 42-71]; P=0.02, respectively). Furthermore, OTRT was also significantly shorter in the post-C-ECG period compared to the pre-C-ECG period (Pre: 190 min [IQR; 137-343] vs. Post: 153 min [IQR; 110-247]; P=0.02). However, peak-CPK and in-hospital mortality were not significantly different between the two periods (Pre: 2254 IU/L [IQR; 1153-4257] vs. Post: 1985 IU/L [IQR; 740-4021]; P=0.2, Pre: 5.9% vs. Post: 4.4%; P=0.7, respectively). Conclusion: Prehospital mobile cloud ECG transmission system reduced not only the DTBT but also OTRT.

Download Full-text

FIVE-YEAR IMPLEMENTATION OF A COMPREHENSIVE ST-ELEVATION MYOCARDIAL INFARCTION PROTOCOL LEADS TO SUSTAINED IMPROVEMENTS IN DOOR-TO-BALLOON TIME, IN-HOSPITAL MORTALITY RATE, AND BLEEDING COMPLICATION RATE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)02293-2 ◽

2021 ◽

Vol 77 (18) ◽

pp. 934

Author(s):

Weili Zheng ◽

Chetan Huded ◽

Anirudh Kumar ◽

Michael Johnson ◽

Kathleen Kravitz ◽

...

Keyword(s):

Myocardial Infarction ◽

Mortality Rate ◽

Hospital Mortality ◽

Complication Rate ◽

Bleeding Complication ◽

St Elevation Myocardial Infarction ◽

St Elevation ◽

Door To Balloon

Download Full-text

Prehospital 12-Lead ECG to Triage ST-Elevation Myocardial Infarction and Emergency Department Activation of the Infarct Team Significantly Improves Door-to-Balloon Times

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.109.892372 ◽

2009 ◽

Vol 2 (6) ◽

pp. 528-534 ◽

Cited By ~ 50

Author(s):

Adam W. Hutchison ◽

Yuvaraj Malaiapan ◽

Ian Jarvie ◽

Bill Barger ◽

Edward Watkins ◽

...

Keyword(s):

Myocardial Infarction ◽

Emergency Department ◽

St Elevation Myocardial Infarction ◽

St Elevation ◽

Door To Balloon

Download Full-text

Impact of collateralisation to a concomitant chronic total occlusion in patients with ST-elevation myocardial infarction: a subanalysis of the EXPLORE randomised controlled trial

Open Heart ◽

10.1136/openhrt-2018-000810 ◽

2018 ◽

Vol 5 (2) ◽

pp. e000810 ◽

Cited By ~ 2

Author(s):

Ivo M van Dongen ◽

Joëlle Elias ◽

K Gert van Houwelingen ◽

Pierfrancesco Agostoni ◽

Bimmer E P M Claessen ◽

...

Keyword(s):

Myocardial Infarction ◽

Clinical Decision Making ◽

Controlled Trial ◽

Left Ventricular ◽

St Elevation Myocardial Infarction ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Significant Difference ◽

St Elevation ◽

The Impact

ObjectiveThe impact on cardiac function of collaterals towards a concomitant chronic total coronary occlusion (CTO) in patients with ST-elevation myocardial infarction (STEMI) has not been investigated yet. Therefore, we have evaluated the impact of well-developed collaterals compared with poorly developed collaterals to a concomitant CTO in STEMI.Methods and resultsIn the EXPLORE trial, patients with STEMI and a concomitant CTO were randomised to either CTO percutaneous coronary intervention (PCI) or no-CTO PCI. Collateral grades were scored angiographically using the Rentrop grade classification. Left ventricular ejection fraction (LVEF) and left ventricular end-diastolic volume (LVEDV) at 4 months were measured using cardiac magnetic resonance imaging. Well-developed collaterals (Rentrop grades 2–3) to the CTO were present in 162 (54%) patients; these patients had a significantly higher LVEF at 4 months (46.2±11.4% vs 42.1±12.7%, p=0.004) as well as a trend for a lower LVEDV (208.2±55.7 mL vs 222.6±68.5 mL, p=0.054) when compared with patients with poorly developed collaterals to the CTO. There was no significant difference in the total amount of scar in the two groups. Event rates were statistically comparable between patients with well-developed collaterals and poorly developed collaterals to the CTO at long-term follow-up.ConclusionsIn patients with STEMI and a concomitant CTO, the presence of well-developed collaterals to a concomitant CTO is associated with a better LVEF at 4 months. However, this effect on LVEF did not translate into improvement in clinical outcome. Therefore, the presence of well-developed collaterals is important, but should not solely guide in the clinical decision-making process regarding any additional revascularisation of a concomitant CTO in patients with STEMI.Clinical trial registrationNTR1108.

Download Full-text

Abstract 9764: Clinical Characteristics and Temporal Trends Among Patients Presenting Late (>12 Hours After Symptom Onset) With ST-Elevation Myocardial Infarction - A Report From the NCDR®

Circulation ◽

10.1161/circ.130.suppl_2.9764 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Praneet K Sharma ◽

Matthew T Roe ◽

Faraz Kureshi ◽

DaJuanicia N Holmes ◽

Brahmajee K Nallamothu ◽

...

Keyword(s):

Myocardial Infarction ◽

Symptom Onset ◽

Temporal Trends ◽

Late Presentation ◽

St Elevation Myocardial Infarction ◽

Primary Pci ◽

Hospital Outcomes ◽

Late Presenters ◽

St Elevation ◽

Door To Balloon

Background: Late presentation after ST-elevation myocardial infarction (STEMI) is associated with poor outcomes. However, contemporary data regarding management and outcomes of such patients are lacking. Methods: Using data from the ACTION Registry-GWTG, we identified 170,247 patients who presented with STEMI to 688 US sites, between 7/08 and 12/13. Patients were stratified according to time from symptom onset to presentation as timely presenters (<12 hours) and late presenters (≥12 hours). Baseline characteristics, management and in-hospital outcomes were compared between the groups. Among late presenters, temporal trends in reperfusion strategy were also examined. Results: A total of 9389 patients (5.5%) had late presentation and 160,858 (94.5%) had timely presentation. Late presenters were more frequently elderly, female and of non-White ethnicity (Table). Late presenters were less likely to have prior MI or prior revascularization, but more likely to have diabetes. Compared with timely presenters, late presenters had worse in-hospital outcomes including mortality (6.3% vs. 5.2%; p<0.0001). Over the 6-year study period, the proportion of late presenters decreased slightly (5.8 vs. 5.4% respectively; p=0.03), while the proportion of late presenters undergoing primary PCI increased from 65% to 71% (p<0.001). Over the same time-period, among late presenters, median time from symptom onset to presentation increased slightly, door to balloon time decreased, and in-hospital mortality remained unchanged (6.0% vs. 6.0%). Conclusions: In contemporary practice, a modest proportion of STEMI patients continue to present >12 hours after symptom onset. Despite increased use of primary PCI and reduction in door-to-balloon times, the unadjusted mortality remains high among late presenters. Continued efforts to educate the public in order to reduce the proportion of late presenters remains warranted.

Download Full-text

Towards prompt electrocardiogram acquisition in triage: Preliminary testing of a symptom-based clinical prediction rule for the Android tablet

European Journal of Cardiovascular Nursing ◽

10.1177/1474515118821023 ◽

2019 ◽

Vol 18 (4) ◽

pp. 289-298

Author(s):

Sharon O’Donnell ◽

Peter Monahan ◽

Gabrielle McKee ◽

Geraldine McMahon ◽

Elizabeth Curtin ◽

...

Keyword(s):

Myocardial Infarction ◽

Emergency Department ◽

Acute Coronary Syndrome ◽

Prediction Rule ◽

Clinical Prediction Rule ◽

St Elevation Myocardial Infarction ◽

Clinical Prediction ◽

Coronary Syndrome ◽

Significant Difference ◽

St Elevation

Background: For patients with suspected acute coronary syndrome, international guidelines indicate that an Electrocardiogram (ECG) should be performed within 10 min of first medical contact, however success at achieving these guidelines is limited. Aims: The purpose of this study was to develop and perform initial testing of a clinical prediction rule embedded in a tablet application, and to expedite the identification of patients who require an electrocardiogram within 10 min. Methods: This derivation of the Acute Coronary Syndrome Application (AcSAP) comprised of three local studies, an unpublished audit and literature critique. The AcSAP was prospectively tested over four months in patients presenting to the Emergency Department (ED) of a Dublin teaching hospital. An audit form retrieved data pertaining to times of: registration to the emergency department, triage, first electrocardiogram and diagnosis. The AcSAP was subsequently evaluated by experienced triage nurses ( n=18) who had utilised it. Results: The AcSAP was activated 379 times. Patients with ST Elevation Myocardial Infarction (STEMI) and non-ST Elevation Myocardial Infarction (NSTEMI) were significantly more likely to return a categorisation of ‘immediate ECG’ or ‘ECG within 10 min’ ( p<0.001). There was a significant difference in ‘triage to ECG’ times across categories, the ‘immediate ECG’ categorisation resulting in the shortest time ( p=0.002). Evaluations suggest that staff found the tool quick and easy to use and results seemed accurate. Conclusion: Testing of the AcSAP suggests that it accurately identifies patients who require an ECG within 10 min. As such, it has the potential to support the meeting of clinical guidelines for ECG acquisition.

Download Full-text