scholarly journals Door-to-balloon Time for ST-elevation MI in the Coronavirus Disease 2019 Era

2021 ◽  
Vol 15 ◽  
Author(s):  
Haytham Mously ◽  
Nischay Shah ◽  
Zachary Zuzek ◽  
Ibrahim Alshaghdali ◽  
Adham Karim ◽  
...  
Keyword(s):  
Symptom Onset ◽  
Treatment Modality ◽  
Arrival Time ◽  
Coronary Intervention ◽  
Hospital Arrival ◽  
Improved Outcomes ◽  
St Elevation ◽  
Door To Balloon ◽  
The Impact

In patients presenting with ST-elevation MI, prompt primary coronary intervention is the preferred treatment modality. Several studies have described improved outcomes in patients with door-to-balloon (D2B) and symptom onset-to-balloon (OTB) times of less than 2 hours, but the specific implications of the coronavirus disease 2019 (COVID-19) pandemic on D2B and OTB times are not well-known. This review aims to evaluate the impact of COVID-19 on D2B time and elucidate both the factors that delay D2B time and strategies to improve D2B time in the contemporary era. The search was directed to identify articles discussing the significance of D2B times before and during COVID-19, from the initialization of the database to December 1, 2020. The majority of studies found that onset-of-symptom to hospital arrival time increased in the COVID-19 era, whereas D2B time and mortality were unchanged in some studies and increased in others.

scholarly journals Prehospital times in primary percutaneous coronary intervention: The new frontier for improvement

2020 ◽  
Vol 46 (2) ◽  
Author(s):  
James A Kiberd ◽  
George Kephart ◽  
Iqbal Bata ◽  
Ata-Ur Quraishi
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Symptom Onset ◽  
Hospital Setting ◽  
Coronary Intervention ◽  
Ischemic Time ◽  
Percutaneous Coronary ◽  
Short And Long Term ◽  
St Elevation ◽  
Door To Balloon

Background: Primary percutaneous coronary intervention (PPCI) remains the treatment of choice for patients presenting with ST-elevation myocardial infarction (STEMI). With STEMI, total ischemic time is an important predictor of myocardial injury and other short and long-term adverse events including mortality. Several studies have examined ‘Door to Balloon’ times, but few studies have examined pre-hospital and in hospital component times as individual pieces that make up total ischemic time. Methods: Total ischemic and component times for patients who received PPCI from 2012- 2015 in the Queen Elizabeth-II Halifax Infirmary were described. Median total ischemic times and component times were calculated and compared. Regression modeling was performed to identify which component times and component variables explained the most variation in total ischemic times. Results: 551 patients who had successful PPCI and complete component times were identified. Most were male (76%) with a median age of 59.2 years (IQR: 52.7-68.0 years). The longest component time was ‘Symptom Onset to First Medical Contact’ (Median: 61 min, IQR: 32-138 min). ‘Symptom Onset to First Medical Contact’ was found to account for most of the variation seen in total ischemic time (R2= 61%). Conclusions: We determined that most time in the component of receiving PPCI lies in the pre-hospital setting and that component variables including EHS use and pre-activation of the cardiac catheter lab reduce total ischemic time. More research needs to be devoted to reducing patient delay, as thereappears to be little room for improvement in hospital component times.

scholarly journals The impact of lockdown enforcement during the SARSCoV-2 pandemic on the timing of presentation and early outcomes of patients with ST-elevation myocardial infarction

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
O Kobo ◽  
R Efraim ◽  
M Saada ◽  
N Kofman ◽  
A Abu Dogosh ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Volume ◽  
Coronary Intervention ◽  
Hemodynamic Instability ◽  
St Elevation Myocardial Infarction ◽  
Funding Sources ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Door To Balloon ◽  
The Impact

Abstract Funding Acknowledgements Type of funding sources: None. We aimed to explore whether the lockdown enforced during the SARSCoV-2 pandemic in Israel impacted the characteristics of presentation, reperfusion times, and early outcomes of ST-elevation myocardial infarction (STEMI) patients. Methods A multicenter prospective cohort comprising all STEMI patients treated by primary percutaneous coronary intervention admitted to four high-volume cardiac centers in Israel during lockdown (20/3/2020 - 30/4/2020). STEMI patients treated during the same period in 2019 served as controls. Results The study comprised 243 patients, 107 during the lockdown period of 2020 and 136 during the same period in 2019, with no difference in demographics and clinical characteristics. Patients admitted in 2020 had higher admission and peak troponin levels, had a 2.4 fold greater likelihood of Door-to-balloon times> 90 min (95%CI: 1.2-4.9, p = 0.01) and 3.3 fold greater likelihood of pain-to-balloon times> 12 hours (OR 3.3, 95%CI: 1.3-8.1, p < 0.01). They experienced higher rates hemodynamic instability (25.2% vs 14.7%, p = 0.04), longer hospital stay (median, IQR [4 ,3-6 Vs 5, 4-6 ,p = 0.03]), and fewer early (<72 hours) discharge (12.4% Vs 32.4%, p < 0.001). Conclusions The lockdown imposed during the SARSCoV-2 pandemic was associated with a significant lag in the time to reperfusion of STEMI patients. Lockdown period 2020OR (95% CI)P valueD2B > 90 min2.4 (1.2-4.9)0.01P2B > 12 hours3.3 (1.3-8.1)<0.01D2B: Door-to-Balloon, P2B: Pain-to-BalloonReference group: 2019 admissions; Adjusted to age, gender, ischemic heart disease, hypertension, Smoker, diabetes mellitus, and dyslipidemia. D2B: Door-to-Balloon, P2B: Pain-to-Balloon

Abstract 12983: Impact of Door to Balloon Time on Outcome of Patients Presenting With Different Symptom Onset to Door Time

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Razvan T Dadu ◽  
Ana Davis ◽  
Jaromir Bobek ◽  
Mahboob Alam ◽  
Rajiv Goswami ◽  
...  
Keyword(s):  
Symptom Onset ◽  
Primary Outcome ◽  
Tertiary Care ◽  
Composite Endpoint ◽  
Coronary Intervention ◽  
Late Presentation ◽  
Secondary Outcome ◽  
Significant Difference ◽  
St Elevation ◽  
The Impact

Objective: Delay in reperfusion > 4h in patients with ST elevation myocardial infarction (STEMI) is associated with negative outcomes. We sought out to examine the impact of DTBT on 30-day cardiovascular outcomes and persistent ST elevation (STE) on the post reperfusion EKG, in patients with different symptom onset to door time (SOTDT). Methods: 122 consecutive patients undergoing primary percutaneous coronary intervention for STEMI in a tertiary care county hospital from 2011-2013 are included. All patients had DTBT ≤ 90min. Patients were divided into 3 groups according to their SOTDT: Group1 ≤ 90min, Group2 between 90min and 4h and Group3 >4h. Each group was further divided in 2 subgroups based on median DTBT of the entire population. The primary outcome was a composite endpoint of mortality, re-hospitalization for chest pain or heart failure, repeat revascularization and re-infarction at 30 days. A secondary outcome was persistence of > 50% STE on the post reperfusion EKG. Results: Median SOTDT was 129 min and the median DTBT was 47min for all included patients in the study. The 3 groups had comparable baseline characteristics. The mean DTBT was similar (49±20 min, 47±18 min and 50±16 min, p=0.7). In the 3 groups, the primary outcome was present in 16.7 %, 16.2 % and 35%, respectively (p=0.08) and there was a significant difference in STE resolution: 16.7%, 17.1% and 78.6%, respectively (p<0.001). Group 1 and 3 demonstrate that short DTBT (≤ 47 min) does not affect overall outcomes compared to those with longer DTBT (> 47 min). In group 2, patients with DTBT ≤ 47min had significantly lower persistent STE on EKG (0% vs 36.8%, p=0.002) and a trend to a favorable clinical outcome (table). Conclusion: Patients with intermediate SOTDT seem to benefit mostly from shorter DTBT compared to all other patient groups. Achieving shorter DTBT may have no impact on outcome in patients with very early or very late presentation. Larger studies are needed to further confirm these findings.

scholarly journals Review of Irish patients meeting ST elevation criteria during the COVID-19 pandemic

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001716
Author(s):  
Luke Byrne ◽  
Roisin Gardiner ◽  
Patrick Devitt ◽  
Caleb Powell ◽  
Richard Armstrong ◽  
...  
Keyword(s):  
Public Health ◽  
Public Perception ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Ventricular Ejection Fraction ◽  
St Elevation ◽  
The Impact ◽  
Transfer Times

IntroductionThe COVID-19 pandemic has seen the introduction of important public health measures to minimise the spread of the virus. We aim to identify the impact government restrictions and hospital-based infection control procedures on ST elevation myocardial infarction (STEMI) care during the COVID-19 pandemic.MethodsPatients meeting ST elevation criteria and undergoing primary percutaneous coronary intervention from 27 March 2020, the day initial national lockdown measures were announced in Ireland, were included in the study. Patients presenting after the lockdown period, from 18 May to 31 June 2020, were also examined. Time from symptom onset to first medical contact (FMC), transfer time and time of wire cross was noted. Additionally, patient characteristics, left ventricular ejection fraction, mortality and biochemical parameters were documented. Outcomes and characteristics were compared against a control group of patients meeting ST elevation criteria during the month of January.ResultsA total of 42 patients presented with STEMI during the lockdown period. A significant increase in total ischaemic time (TIT) was noted versus controls (8.81 hours (±16.4) vs 2.99 hours (±1.39), p=0.03), with increases driven largely by delays in seeking FMC (7.13 hours (±16.4) vs 1.98 hours (±1.46), p=0.049). TIT remained significantly elevated during the postlockdown period (6.1 hours (±5.3), p=0.05), however, an improvement in patient delays was seen versus the control group (3.99 hours (±4.5), p=0.06). There was no difference seen in transfer times and door to wire cross time during lockdown, however, a significant increase in transfer times was seen postlockdown versus controls (1.81 hours (±1.0) vs 1.1 hours (±0.87), p=0.004).ConclusionA significant increase in TIT was seen during the lockdown period driven mainly by patient factors highlighting the significance of public health messages on public perception. Additionally, a significant delay in transfer times to our centre was seen postlockdown.

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

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.

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

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.

scholarly journals In the transition from fibrinolysis to primary PCI, the HERO trials help refine STEMI ECG interpretation and Q wave analysis potentially alters future management

2018 ◽  
Vol 9 (1_suppl) ◽  
pp. 26-33
Author(s):  
Cheuk-Kit Wong ◽  
Harvey D White
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Symptom Onset ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Time Duration ◽  
Duration Of Symptoms ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Q Wave

Electrocardiogram sub-studies from the Hirulog Early Reperfusion/Occlusion 1 and 2 trials, which tested bivalirudin as an adjunctive anticoagulant to fibrinolysis in ST-elevation myocardial infarction, have contributed to the literature. The concept of using the presence of infarct lead Q waves to determine reperfusion benefit has subsequently been explored in multiple primary percutaneous coronary intervention studies. The angiographic findings before percutaneous coronary intervention combine with the baseline electrocardiogram to accurately diagnose ST-elevation myocardial infarction and evaluate its potential territory. This review discusses the relative merits of the presence of infarct lead Q waves versus time duration from symptom onset using observational data from cohorts of patients from multiple clinical trials. The presence of infarct lead Q waves at presentation has been repeatedly shown to be superior to time duration from symptom onset in determining prognosis, despite that continuous variable (time duration) statistically should be more powerful than dichotomous variable (Q wave). If quantitative or semi-quantitative measurement of Q waves correlates well with irreversible myocardial injury in vivo (a research goal of many cardiac magnetic resonance imaging studies), Q waves measurements by mirroring ST-elevation myocardial infarction evolution better than the current metric of time duration of symptoms will impact future ST-elevation myocardial infarction reperfusion management. Newer methodology will more quickly capture and transmit electrocardiogram information including infarct lead Q waves potentially before first medical contact, and help differentiate new evolving Q waves of the ongoing ST-elevation myocardial infarction from old changes. Q waves as the new metric in ST-elevation myocardial infarction reperfusion should be tested in upcoming trials.

Abstract 16688: Trans-Satellite Wireless 12 Lead ECG Transmission From the Ambulance to the Primary PCI Facility as Part of Nationwide Primary PCI Program for ST-Elevation Myocardial Infarction

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Abdurrazzak Gehani ◽  
Jassim Al Suwaidi ◽  
Omer Tamimi ◽  
Salah Arafa ◽  
Awad Al Qahtani ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Ethnic Difference ◽  
Primary Pci ◽  
Emergency Rooms ◽  
Total Delay ◽  
St Elevation ◽  
Door To Balloon ◽  
The Impact ◽  
Heart Hospital

Introduction: Time is recognized as a crucial factor in the success of Primary PCI (PPCI). We have installed a “Nationwide” Trans-Satellite Wireless ECG Transfer (W-ECG) which enables swift identification of STEMI and direct transfer to the PPCI facility in Heart Hospital (HH). It also initiates PPCI staff to be ready even before patient arrives, and eliminates delays in Emergency rooms. Methods: Of 510 patients who had PPCI for STEMI, 282 (55%) were transferred directly to the Heart Hospital (HH). These were compared with 228 patients (45%) who went to other hospitals first (OH) before transfer to the HH. Age was similar 50.2 vs 50 years and there was no Ethnic difference (73% Asians and 26% Arabs) in both groups. We compared the two with regard to achieving the optimal Door to Balloon Time (DBT) of 90min for PPCI facility (HH), versus 120min for the OH group, as per guidelines. Results: The DBT was 53±23min for HH group vs 104±55min in OH group (p<0.001). However, while 88% achieved <90min in HH group, only 70% achieved <120min in OH group, p<0.001. Furthermore, Out of Hospital Delay ( OHD i.e delay from symptoms until arrival to hospital) was also different. Patients who had W-ECG arrived faster to HH and thus had shorter OHD (198±183min) than those using own transport to HH (287±276min). Although OHD was longer in HH group (216±212) than OH group (201±172min), the combined OHD+DBT= (Total delay from symptoms to Balloon) was still shorter in HH (W-ECG) group (269min) than similar group going to OH (305min), thus saving 36 vital minutes. Although initial TIMI-0 flow was similar (HH 46% vs OH 44%), TIMI-III flow was achieved more often in HH (97%) than in OH group (92%). Peak Troponin (ng/ml) was also higher in OH group (71251) vs (6576) in HH, p<0.05. While Ejection fraction was similar (HH 45% vs OH 43%), in-hospital mortality was higher in OH group (3.5%) vs (2.5%) in HH, p=0.05. Length of stay was also longer in OH (4.3±4.7) compared to 3.4±3.1 in HH group, p=0.005. Conclusion: Trans-satellite wireless ECG from the ambulance to Primary PCI facility results in significantly shorter DBT, total symptoms to balloon time, and length of stay, as well lower peak Troponin and a trend towards lower in-hospital mortality. Continued study and wider use will further confirm the impact of this technology.

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