NEW YORK (Reuters Health) – A novel protocol that significantly reduces "door-to-balloon time" for patients with ST-elevation myocardial infarction (STEMI) leads to a reduction in infarct size and total hospital costs, a team in Indiana reports.
These findings appear in a rapid access issue of Circulation; Journal of the American Heart Association, slated for publication on July 3.
According to lead author Dr. Umesh N. Khot, from Indiana Heart Physicians in Indianapolis, and colleagues, only about one third of STEMI patients in the U.S. meet the goal of undergoing percutaneous coronary intervention (PCI) within 90 minutes after presentation in the emergency department (ED).
In the traditional approach, ED physicians request a cardiology evaluation for STEMI patients, after which the cardiologist activates the cath lab. PCI is performed after the cath lab is activated and off-duty staff members have arrived.
The new protocol mandates that the ED physician activate the cath lab. In addition, the patients are transferred immediately to the cath lab by an in-house emergency heart attack response team, comprised of an ED nurse, a critical care unit nurse, and a chest pain unit nurse.
Dr. Khot and fellow investigators recorded door-to-balloon times for 60 consecutive STEMI patients undergoing emergency PCI between October 1, 2004 and August 31, 2005. The research team also collected the same information for 86 patients from September 1, 2005, until June 26, 2006, after the new protocol was put in place.
Median door-to-balloon time decreased from 113.5 to 75.5 minutes (p < 0.0006). The proportion of patients treated within 90 minutes increased from 28% to 71% (p = 0.001).
The shorter door-to-balloon times were maintained regardless of time of day, mode of transportation to the hospital, and patients’ clinical characteristics.
As a result of more timely treatment, peak creatinine kinase levels, an indicator of infarct size, were reduced from approximately 2600 IU/L to 1500 IU/L.
Mean hospital length of stay fell from 5 days to 3 days after implementing the new protocol, and mean total hospital costs declined from $27,000 to $18,000.
"Widespread implementation of this simple strategy can substantially improve the quality of care of STEMI patients undergoing emergency PCI," Dr. Khot and associates conclude.
