Document Detail


Emergency department activation of an interventional cardiology team reduces door-to-balloon times in ST-segment-elevation myocardial infarction.
MedLine Citation:
PMID:  17963981     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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:
Type:  Journal Article    
Journal Detail:
Title:  Annals of emergency medicine     Volume:  50     ISSN:  1097-6760     ISO Abbreviation:  Ann Emerg Med     Publication Date:  2007 Nov 
Date Detail:
Created Date:  2007-10-29     Completed Date:  2007-11-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8002646     Medline TA:  Ann Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  538-44     Citation Subset:  AIM; IM    
Affiliation:
Department of Emergency Medicine, Stony Brook University, Stony Brook, NY 11794-8500, USA. adam.singer@stonybrook.edu
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MeSH Terms
Descriptor/Qualifier:
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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