鈥淐ode STEMI鈥?Protocol Helps in Achieving Reduced Door-to-balloon Times in Patients Presenting with Acute ST-segment Elevation Myocardial Infarction during Off-hours

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• 作者：Sharad Bajaj ; MD^&lowast ; ; Rupen Parikh ; MD^&dagger ; ; Nishant Gupta ; MD^&lowast ; ; Anthony Aldehneh ; MD^&dagger ; ; Mark Rosenberg ; DO ; FACEP^&Dagger ; ; Aiman Hamdan ; MD ; FACC ; FSCAI^&dagger ; ; Mahesh Bikkina ; MD ; FACC ; FSCAI^&dagger ; ; ^{bikkinam@sjhmc.org}
• 关键词：Code STEMI protocol ; Door-to-balloon time ; Off-hours ; ST-elevation myocardial infarction
• 刊名：Journal of Emergency Medicine
• 出版年：2012
• 期刊代码：156_07364679
• 类别：med
• 出版时间：March, 2012
• 卷：42
• 期：3
• 页码：260-266
• 文件大小：457 K

摘要

Background

Door-to-balloon (D2B) time is conceived as a crucial parameter for evaluating the quality of acute ST-segment elevation myocardial infarction (STEMI) care. Ideally, primary percutaneous intervention should be performed within 90 min of hospital arrival.

Objectives

We sought to determine the impact of emergency physician-activated 鈥淐ode STEMI鈥?protocol on door-to-balloon times during off-hours.

Methods

Patients were divided into two study groups: one group consisted of 27 STEMI patients who presented during off-hours in the pre-Code STEMI period (January to December 2006) and the second group consisted of 60 STEMI patients admitted during off-hours when Code STEMI was fully operational (January 2007 to December 2008). The primary objective was to compare median D2B times in both the study groups. Secondary parameters of interest included the individual components of D2B time, peak serum troponin levels, peak creatine kinase total levels, all-cause in-hospital mortality, 6-month all-cause mortality, and 12-month all-cause mortality.

Results

With the implementation of 鈥淐ode STEMI鈥?protocol, the median D2B time during off-hours dropped to 77 min (interquartile range [IQR] 67-95), representing a 52-min improvement (p = 0.0001). ECG-to-catheterization laboratory time demonstrated absolute reduction of 16 min. Median peak troponin-I levels dropped from 62 ng/mL (IQR 23-142) to 25 ng/mL (IQR 7-43; p < 0.002). No statistically significant differences were perceived in all-cause mortality among the study groups.

Conclusions

Implementation of 鈥淐ode STEMI鈥?protocol at our institution significantly reduced D2B times for STEMI during off-hours.