on February 7, 2005
Circulation. 2005
Published online before print February 7, 2005, doi: 10.1161/01.CIR.0000155258.44268.F8
Published online before print February 7, 2005, doi: 10.1161/01.CIR.0000155258.44268.F8
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Submitted on August 16, 2004
From the Health Services Research and Development Center for Excellence (B.K.N.), Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Mich; the Department of Internal Medicine (B.K.N., E.R.B.), Division of Cardiovascular Disease, University of Michigan Medical School, Ann Arbor; Flying Buttress Associates (J.H.), Charlottesville, Va; the Section of Health Policy and Administration (E.H.B., H.M.K.), Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn; and the Department of Internal Medicine (Y.W., H.M.K.), Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Conn. * To whom correspondence should be addressed. E-mail: harlan.krumholz{at}yale.edu.
Background--Treatment delays in patients with ST-segment-elevation myocardial infarction (STEMI) transferred for primary percutaneous coronary intervention (PCI) may decrease the advantage of this strategy over on-site fibrinolytic therapy that has been demonstrated in recent clinical trials. Accordingly, we sought to describe patterns of times to treatment in patients undergoing interhospital transfer for primary PCI in the United States. Methods and Results--We analyzed patients with STEMI undergoing interhospital transfer for primary PCI between January 1999 and December 2002 in the National Registry of Myocardial Infarction. The primary outcome was "total" door-to-balloon time measured from time of arrival at the initial hospital to time of balloon inflation at the PCI hospital. Multivariable hierarchical models were used to assess the relationship of total door-to-balloon time with patient and hospital characteristics. Among 4278 patients transferred for primary PCI at 419 hospitals, the median total door-to-balloon time was 180 minutes, with only 4.2% of patients treated within 90 minutes, the benchmark recommended by national quality guidelines. Comorbid conditions, absence of chest pain, delayed presentation after symptom onset, less specific ECG findings, and hospital presentation during off-hours were associated with longer total door-to-balloon times. Patients at teaching hospitals in rural areas also had significantly longer times to treatment. Conclusions--Total door-to-balloon times for transfer patients undergoing primary PCI in the United States rarely achieve guideline-recommended benchmarks, and current decision making should take these times into account. For the full benefits of primary PCI to be realized in transfer patients, improved systems are urgently needed to minimize total door-to-balloon times.
Revised on November 1, 2004
Accepted on November 16, 2004
Times to Treatment in Transfer Patients Undergoing Primary Percutaneous Coronary Intervention in the United States. National Registry of Myocardial Infarction (NRMI)-3/4 Analysis
Brahmajee K. Nallamothu MD, MPH,
Key words: catheterization • myocardial infarction • angioplasty • health policy
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P. W. Armstrong and WEST Steering Committee A comparison of pharmacologic therapy with/without timely coronary intervention vs. primary percutaneous intervention early after ST-elevation myocardial infarction: the WEST (Which Early ST-elevation myocardial infarction Therapy) study Eur. Heart J., July 1, 2006; 27(13): 1530 - 1538. [Abstract] [Full Text] [PDF]
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S. J. Walsh, C. G. Owens, and A. A. J. Adgey Pre-hospital diagnosis of myocardial infarction: an opportunity to improve outcomes? Eur. Heart J., July 1, 2006; 27(13): 1515 - 1516. [Full Text] [PDF]
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V. Rajagopal and D. L. Bhatt Gaps in myocardial infarction care: how might we best EFFECT change? Eur. Heart J., July 1, 2006; 27(13): 1513 - 1514. [Full Text] [PDF]
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K. Kalla, G. Christ, R. Karnik, R. Malzer, G. Norman, H. Prachar, W. Schreiber, G. Unger, H. D. Glogar, A. Kaff, et al. Implementation of Guidelines Improves the Standard of Care: The Viennese Registry on Reperfusion Strategies in ST-Elevation Myocardial Infarction (Vienna STEMI Registry) Circulation, May 23, 2006; 113(20): 2398 - 2405. [Abstract] [Full Text] [PDF]
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The American Heart Association's Acute Myocardial, A. K. Jacobs, E. M. Antman, G. Ellrodt, D. P. Faxon, T. Gregory, G. A. Mensah, P. Moyer, J. Ornato, E. D. Peterson, et al. Recommendation to Develop Strategies to Increase the Number of ST-Segment-Elevation Myocardial Infarction Patients With Timely Access to Primary Percutaneous Coronary Intervention Circulation, May 2, 2006; 113(17): 2152 - 2163. [Abstract] [Full Text] [PDF]
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S. R. Dixon, C. L. Grines, and W. W. O'Neill The Year in Interventional Cardiology J. Am. Coll. Cardiol., April 18, 2006; 47(8): 1689 - 1706. [Full Text] [PDF]
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S. S. Rathore, A. J. Epstein, B. K. Nallamothu, and H. M. Krumholz Regionalization of ST-Segment Elevation Acute Coronary Syndromes Care: Putting a National Policy in Proper Perspective J. Am. Coll. Cardiol., April 4, 2006; 47(7): 1346 - 1349. [Abstract] [Full Text] [PDF]
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E. Boersma and The Primary Coronary Angioplasty vs. Thrombolysis Does time matter? A pooled analysis of randomized clinical trials comparing primary percutaneous coronary intervention and in-hospital fibrinolysis in acute myocardial infarction patients Eur. Heart J., April 1, 2006; 27(7): 779 - 788. [Abstract] [Full Text] [PDF]
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B. K. Nallamothu, E. R. Bates, Y. Wang, E. H. Bradley, and H. M. Krumholz Driving Times and Distances to Hospitals With Percutaneous Coronary Intervention in the United States: Implications for Prehospital Triage of Patients With ST-Elevation Myocardial Infarction Circulation, March 7, 2006; 113(9): 1189 - 1195. [Abstract] [Full Text] [PDF]
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B. R. Brodie, C. Hansen, T. D. Stuckey, S. Richter, D. S. VerSteeg, N. Gupta, W. E. Downey, and M. Pulsipher Door-to-Balloon Time With Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction Impacts Late Cardiac Mortality in High-Risk Patients and Patients Presenting Early After the Onset of Symptoms J. Am. Coll. Cardiol., January 17, 2006; 47(2): 289 - 295. [Abstract] [Full Text] [PDF]
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B. K. Nallamothu, Y. Wang, D. J. Magid, R. L. McNamara, J. Herrin, E. H. Bradley, E. R. Bates, C. V. Pollack Jr, H. M. Krumholz, and for the National Registry of Myocardial Infarction Relation Between Hospital Specialization With Primary Percutaneous Coronary Intervention and Clinical Outcomes in ST-Segment Elevation Myocardial Infarction: National Registry of Myocardial Infarction-4 Analysis Circulation, January 17, 2006; 113(2): 222 - 229. [Abstract] [Full Text] [PDF]
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Part 8: Stabilization of the Patient With Acute Coronary Syndromes Circulation, December 13, 2005; 112(24_suppl): IV-89 - IV-110. [Full Text] [PDF]
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J.-P. Bassand, N. Danchin, G. Filippatos, A. Gitt, C. Hamm, S. Silber, M. Tubaro, and F. Weidinger Implementation of reperfusion therapy in acute myocardial infarction. A policy statement from the European Society of Cardiology Eur. Heart J., December 2, 2005; 26(24): 2733 - 2741. [Abstract] [Full Text] [PDF]
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T. P. Wharton Jr, E. C. Keeley, C. L. Grines, T. P. Wharton Jr, E. C. Keeley, and C. L. Grines The Case for Community Hospital Angioplasty Circulation, November 29, 2005; 112(22): 3509 - 3534. [Full Text] [PDF]
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H. M. Krumholz The Year in Epidemiology, Health Services, and Outcomes Research J. Am. Coll. Cardiol., October 4, 2005; 46(7): 1362 - 1370. [Full Text] [PDF]
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K. Huber, R. D. Caterina, S. D. Kristensen, F. W.A. Verheugt, G. Montalescot, L. B. Maestro, F. V. d. Werf, and for the Task Force on Pre-hospital Reperfusion The Pre-hospital reperfusion therapy: a strategy to improve therapeutic outcome in patients with ST-elevation myocardial infarction Eur. Heart J., October 1, 2005; 26(19): 2063 - 2074. [Full Text] [PDF]
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P. W. Armstrong Moving proximally through the intersection between the process and the content of care in ST-elevation myocardial infarction Eur. Heart J., October 1, 2005; 26(19): 1937 - 1938. [Full Text] [PDF]
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B. R. Brodie, C. L. Grines, G. W. Stone, B. K. Nallamothu, E. R. Bates, J. Herrin, Y. Wang, E. H. Bradley, and H. M. Krumholz Letter Regarding Article by Nallamothu et al, "Times to Treatment in Transfer Patients Undergoing Primary Percutaneous Coronary Intervention in the United States" * Response Circulation, August 16, 2005; 112(7): e99 - e100. [Full Text] [PDF]
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S. S. Rathore, A. J. Epstein, K. G. M. Volpp, and H. M. Krumholz Acute Coronary Syndromes and Regionalization of Care--Reply JAMA, July 20, 2005; 294(3): 304 - 305. [Full Text] [PDF]
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