scholarly journals Improved door-to-balloon time for primary percutaneous coronary intervention for patients conveyed via emergency ambulance service

2021 ◽  
Vol 50 (9) ◽  
pp. 671-678
Author(s):  
Zhenghong Liu ◽  
Mian Jie Lim ◽  
Pin Pin Pek ◽  
Aaron Sung Lung Wong ◽  
Kenneth Boon Kiat Tan ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Primary Study ◽  
Tertiary Institution ◽  
Early Reperfusion ◽  
Percutaneous Coronary ◽  
Emergency Ambulance ◽  
Door To Balloon ◽  
The Impact

ABSTRACT Introduction: Early reperfusion of ST-segment elevation myocardial infarction (STEMI) results in better outcomes. Interventions that have resulted in shorter door-to-balloon (DTB) time include prehospital cardiovascular laboratory activation and prehospital electrocardiogram (ECG) transmission, which are only available for patients who arrive via emergency ambulances. We assessed the impact of mode of transport on DTB time in a single tertiary institution and evaluated the factors that affected various components of DTB time. Methods: We conducted a retrospective cohort study using registry data of patients diagnosed with STEMI in the emergency department (ED) who underwent primary percutaneous coronary intervention. We compared patients who arrived by emergency ambulances with those who came via their own transport. The primary study end point was DTB, defined as the earliest time a patient arrived in the ED to balloon inflation. As deidentified data was used, ethics review was waived. Results: A total of 321 patients were included for analysis after excluding 7 with missing data. The mean age was 61.4±11.4 years old with 49 (15.3%) females. Ninety-nine (30.8%) patients arrived by emergency ambulance. The median DTB time was shorter for patients arriving by ambulance versus own transport (52min, interquartile range [IQR] 45–61 vs 67min, IQR 59–74; P<0.001), with shorter door-to-ECG and door-to-activation time. Conclusion: Arrival via emergency ambulance was associated with a decreased DTB for STEMI patients compared to arriving via own transport. There is a need for public education to increase the usage of emergency ambulances for suspected heart attacks to improve outcomes. Keywords: Cardiovascular lab activation, door-to-balloon time, emergency ambulance, primary PCI, STEMI

scholarly journals The relationship between coronary anatomy and primary percutaneous coronary intervention features and prognostically unfavorable CMR-based characteristics of acute ST-elevation myocardial infarction

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Terenicheva ◽  
R M Shakhnovich ◽  
O V Stukalova ◽  
E A Butorova ◽  
S K Ternovoy
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Infarct Size ◽  
Primary Percutaneous Coronary Intervention ◽  
Symptom Onset ◽  
Coronary Intervention ◽  
Coronary Anatomy ◽  
Early Reperfusion ◽  
Comparator Group ◽  
Percutaneous Coronary ◽  
The Impact

Abstract Purpose To investigate the impact of coronary anatomy and pPCI parameters on the most prognostically significant MRI measures of acute MI with ST segment elevation (MVO, infarct size). Methods The study included 52 patients with STEMI and primary percutaneous coronary intervention (pPCI) of infarct-related arteries (IRA). On Days 3–7 contrast-enhanced cardiac MRI was done. Tissue analysis of scans was performed evaluating infarct size, presence and size of MVO. Results The study included 52 patients with first STEMI within &lt;48 hours of onset. All patients urgently underwent pPCI for reperfusion. Patients were divided into 2 groups separated by the median time to reperfusion treatment (3 hours). There were no significant differences between groups in MRI-measured EF (In the group with later pPCI (&gt;3 hours of symptom onset EF was 49.0±11.0%, and in the comparator group – 45.7±10.5%, p=0,2). MRI-measured infarct size was significantly higher in the group where pPCI was done &gt;3 hours of symptom onset: 18.1±1.7% of the LV mass, compared to the early reperfusion group – 10.9±1.9% (p=0.009). MVO magnitude was also higher in the later pPCI group (2.6±0.64% vs 0.03±0.3% in the comparator group), (p&lt;0,027). Correlation analysis also revealed a reliable relationship between IS and time to reperfusion (R 0.381, p=0.006). LAD lesions were associated with higher infarct size values (p=0.02) and higher risk of MVO (odds ratio 2.9, CI 0.83–10.0, p=0.03). Complete occlusion of IRA was associated with higher IS (16,97±3.3 vs 12.05±1.4, p=0.02). There was no reliable correlations between IRA patientcy and MVO magnitude (p=0.7). Conclusions In this study pPCI timing, in groups of below and more than 3 hours after symptom onset, had no significant impact on EF, as determined by MRI. However, pPCI timing exceeding 3 hours significantly influenced infarct size, the occurrence and magnitude of microvascular obstruction. LAD being the IRA was associated with larger IS, higher risks of MVO development. Patient IRA was associated with smaller IS as determined by MRI. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Healthcare Russian Federation

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.

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