Faculty Opinions recommendation of Door-to-balloon time and mortality among patients undergoing primary PCI.

2013 ◽  
Author(s):  
Venu Menon ◽  
Bhuvnesh Aggarwal
Keyword(s):  
Primary Pci ◽  
Door To Balloon

scholarly journals Effect of transradial ECG guided immediate intervention on culprit lesion with a single guiding catheter on door to balloon time

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G.J.C Guo ◽  
W.G.Z Wang ◽  
L.Z.J Liu ◽  
L.H.D Li ◽  
N.D Niu ◽  
...  
Keyword(s):  
Fluoroscopy Time ◽  
Health Improvement ◽  
Funding Source ◽  
Primary Pci ◽  
Culprit Lesion ◽  
Catheterization Laboratory ◽  
Catheter Group ◽  
Procedural Time ◽  
Door To Balloon ◽  
Guiding Catheter

Abstract Objective There is limited literature on procedure of primary PCI in catheterization laboratory. This study was designed to assess the impact of electrocardiogram-guided immediate intervention on culprit lesion with a single guiding catheter in ST-elevation myocardial infarction (STEMI) patients on door-to-balloon (D2B) time and clinical outcomes. Methods In this prospective, randomized single center study, 560 patients with STEMI who underwent primary PCI from February 2017 to July 2019 were randomized into two groups. In single catheter group, a single guiding catheter (MAC3.5 or JL 3.5 guiding catheter) was used to perform angiogram and PCI of culprit vessel, followed by contralateral angiography (n=280). In contral group, 280 patients underwent primary PCI after complete diagnostic angiography. The primary evaluation was D2B time and second endpoint include catheterization laboratory-to-balloon (C2B) time, major adverse cardiac events (MACE) at 30 days. This trial was registered with ClinicalTrials.gov, NCT03272451. Results Baseline characteristics were not different between the two groups. The median D2B time (54.83 [IQR 40.00–68.0] min versus 58.32 [IQR 44.12–78.40] min, P=0.007), C2B time (16.91 [IQR 13.88–21.42] min versus 23.80 [IQR 18.92–28.52] min, P<0.001), total procedural time (45.17 [34.06–59.48] min versus 48.51 [37.04–64.60] min, P=0.012) and fluoroscopy time (9.70 [6.50–14.15] min versus 11.26 [8.01–14.27] min, P=0.025)were significantly shorter in single catheter group Compared with control group. The proportion of patients achieving D2B time within 60 minutes increased significantly in the single catheter group (61.79% vs. 52.14%, P=0.021). The rate of radial perforation was significantly reduced in single catheter group (0.71% vs. 3.21%, P=0.033). The total number of catheters was significantly less in single catheter group (1.18±0.54 vs. 2.23±0.60, p<0.001). There was no significant difference in the MACE at 30 days (2.5% vs. 4.64%, P=0.172) between the 2 groups. Conclusion ECG-guided immediate intervention on culprit lesion with a single guiding catheter in STEMI patients can reduce D2B time, C2B time, procedural time and fluoroscopy time. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Capital's Funds for Health Improvement and Research

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 TCT-392 Beyond door-to-balloon time in primary PCI: First medical contact-to-first device time of less than 120 minutes is a reasonable contemporary real-world prognostic target

2017 ◽  
Vol 70 (18) ◽  
pp. B161
Author(s):  
Peter Moore ◽  
Yash Singbal ◽  
Jillian Milne ◽  
Thomas Rosenfeld ◽  
Deepu Balakrishnan ◽  
...  
Keyword(s):  
Real World ◽  
Primary Pci ◽  
Door To Balloon

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.

Abstract 111: Exclusive Involvement of Interventional Cardiologist in the Decision Making Process Improves Door-to-balloon Time by Significant Shortening of Decision-to-balloon Time Instead of EKG-to-decision Time In ST Elevation Myocardial Infarction

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Daming Zhu ◽  
Yuanyuan Zhang ◽  
Nowwar Mustafa ◽  
Angela Hoban ◽  
Dan Murphy ◽  
...  
Keyword(s):  
Decision Making ◽  
Decision Time ◽  
Decision Making Process ◽  
Primary Pci ◽  
Chi Square ◽  
Comprehensive Strategy ◽  
Interventional Cardiologist ◽  
Group 2 ◽  
Door To Balloon ◽  
Group 1

Background: We have had a “one call activation system” for primary PCI at our regional academic center since 1999. The ED physician initiated the system with the decision for primary PCI made by cardiologist (interventional or non-interventional) on call. But since July 1, 2009, only interventional cardiologists are involved in the decision making process. Otherwise, the comprehensive strategy remained the same. As we have reported previously, this new strategy resulted in a shortened door-to-balloon (D2B) time. In the present study, we analyzed the D2B timeline intervals to determine where the major gains were achieved. Methods: We conducted a retrospective analysis of 665 consecutive patients presenting to our institution with suspicion of acute STEMI during a 30-month period. Group 1 consisted of patients in the 12 months (July 1 2008-June 30 2009) before and Group 2 consisted of patients in the 18 months (July 1 2009-Dec. 31 2010) after the system change was instituted. Mann-Whitney U test and chi-square test were used for statistical analysis. Results: 218 patients in group 1 were taken to the cath lab of which 180 received primary PCI. 349 patients in group 2 were taken to the cath lab of which 275 received primary PCI. The results were presented in the table. Conclusions: Comprehensive strategy with exclusive involvement of interventional cardiologist resulted in a significant decrement in decision-to-balloon time. The EKG-to-decision time did not decrease, contrary to our expectation.

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