| Emergency department activation of an interventional cardiology team reduces door-to-balloon times in ST-segment-elevation myocardial infarction. | |
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MedLine Citation:
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PMID: 17963981 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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STUDY OBJECTIVE: American Heart Association/American College of Cardiology guidelines recommend door-to-balloon times of fewer than 90 minutes in patients with acute ST-segment-elevation myocardial infarction. We hypothesized that immediate activation of an interventional cardiology team (code H) would reduce the time to percutaneous coronary intervention by 1 hour and increase the proportion of patients undergoing percutaneous coronary intervention within 90 minutes of arrival. METHODS: Study design was a before-and-after trial in an academic suburban emergency department (ED) with a certified cardiac catheterization laboratory. Subjects were a consecutive sample of patients presenting to the ED with ST-segment-elevation myocardial infarction evident on the initial ECG. Patients without chest pain and refusing catheterization were excluded. The intervention was the use of a central paging system for activation of the interventional cardiology team (attending physician, fellow, nurse, technician) by emergency physicians in patients presenting to the ED with ST-segment-elevation myocardial infarction. Measures were demographic and clinical information collected with standardized data collection forms. Outcomes were door-to-balloon times and the proportion of patients undergoing percutaneous coronary intervention within 90 minutes of arrival. Groups were compared with chi2 and t tests. RESULTS: There were 97 patients included in the study; 43 were treated in the 2 years before implementation of the code H and 54 patients were treated the subsequent 2 years. Mean age (SD) was 56.9 years (13.7), 27% were women, and 86% were white. Groups were similar in age, sex, and race. Implementation of a code H reduced the median door-to-balloon time by 68 minutes (from 176 to 108 minutes; P<.001) and increased the proportion of patients undergoing percutaneous coronary intervention within 90 minutes from 2.8% to 29.0% (mean difference 26.5; 95% confidence interval 15.0 to 36.9). To determine whether further improvements occurred, 48 patients treated in 2006 showed a 20-minute further reduction in door-to-balloon time; 52% underwent angioplasty within 90 minutes of ED presentation. CONCLUSION: Institutional implementation of a protocol that requires emergency physicians to activate an interventional cardiology team response in ED patients with ST-segment-elevation myocardial infarction reduces the door-to-balloon time and increases the proportion of patients undergoing percutaneous coronary intervention within 90 minutes. |
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Authors:
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Adam J Singer; Amit Shembekar; Farid Visram; Joshua Schiller; Valerie Russo; William Lawson; Carol A Gomes; Carolyn Santora; Mary Maliszewski; Lisa Wilbert; Eileen Dowdy; Peter Viccellio; Mark C Henry |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Annals of emergency medicine Volume: 50 ISSN: 1097-6760 ISO Abbreviation: Ann Emerg Med Publication Date: 2007 Nov |
Date Detail:
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Created Date: 2007-10-29 Completed Date: 2007-11-08 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8002646 Medline TA: Ann Emerg Med Country: United States |
Other Details:
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Languages: eng Pagination: 538-44 Citation Subset: AIM; IM |
Affiliation:
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Department of Emergency Medicine, Stony Brook University, Stony Brook, NY 11794-8500, USA. adam.singer@stonybrook.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Angioplasty, Transluminal, Percutaneous Coronary* Emergency Service, Hospital / organization & administration*, statistics & numerical data Female Guideline Adherence Humans Male Middle Aged Myocardial Infarction / therapy* Patient Care Team / organization & administration* Time Factors |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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