Published Online
on June 11, 2007

A more recent version of this article appeared on July 3, 2007

This Article Full Text (PDF) All Versions of this Article: 116/1/67    most recent CIRCULATIONAHA.106.677401v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Khot, U. N. Articles by Berg, W. J. Search for Related Content PubMed PubMed Citation Articles by Khot, U. N. Articles by Berg, W. J. Related Collections Health policy and outcome research Catheter-based coronary interventions: stents CPR and emergency cardiac care Acute myocardial infarction

Submitted on November 20, 2006
Accepted on April 20, 2007

Emergency Department Physician Activation of the Catheterization Laboratory and Immediate Transfer to an Immediately Available Catheterization Laboratory Reduce Door-to-Balloon Time in ST-Elevation Myocardial Infarction

Umesh N. Khot MD^*, Michele L. Johnson RN, Curtis Ramsey MS, Monica B. Khot MD, Randall Todd MD, Saeed R. Shaikh MD, and William J. Berg MD

From the Indiana Heart Physicians, Indianapolis (U.N.K., M.B.K., S.R.S., W.J.B.); St. Francis Hospital and Health Centers, Beech Grove (M.L.J.); Curtis Ramsey and Associates, Indianapolis (C.S.); and Emergency Physicians of Indianapolis, Beech Grove (R.T.), Ind.

^* To whom correspondence should be addressed. E-mail: khot{at}cvresearch.net.

Background--Consensus guidelines and hospital quality-of-care programs recommend that ST-elevation myocardial infarction patients achieve a door-to-balloon time of 90 minutes. However, there are limited prospective data on specific measures to significantly reduce door-to-balloon time.

Methods and Results--We prospectively determined the impact on median door-to-balloon time of a protocol mandating (1) emergency department physician activation of the catheterization laboratory and (2) immediate transfer of the patient to an immediately available catheterization laboratory by an in-house transfer team consisting of an emergency department nurse, a critical care unit nurse, and a chest pain unit nurse. We collected door-to-balloon time for 60 consecutive ST-elevation myocardial infarction patients undergoing emergency percutaneous intervention within 24 hours of presentation from October 1, 2004, through August 31, 2005, and compared this group with 86 consecutive ST-elevation myocardial infarction patients from September 1, 2005, through June 26, 2006, after protocol implementation. Median door-to-balloon time decreased overall (113.5 versus 75.5 minutes; P<0.0001), during regular hours (83.5 versus 64.5 minutes; P=0.005), during off-hours (123.5 versus 77.5 minutes; P<0.0001), and with transfer from an outside affiliated emergency department (147 versus 85 minutes; P=0.0006). Treatment within 90 minutes increased from 28% to 71% (P<0.0001). Mean infarct size decreased (peak creatinine kinase, 2623±3329 versus 1517±1556 IU/L; P=0.0089), as did hospital length of stay (5±7 versus 3±2 days; P=0.0097) and total hospital costs per admission ($26 826±29 497 versus $18 280±8943; P=0.0125).

Conclusions--Emergency department physician activation of the catheterization laboratory and immediate transfer of the patient to an immediately available catheterization laboratory reduce door-to-balloon time, leading to a reduction in myocardial infarct size, hospital length of stay, and total hospital costs.

Key words: angioplasty • myocardial infarction • quality of health care • stents • quality indicators, health care

This article has been cited by other articles:

				D. M. Nestler, A. Noheria, L. H. Haro, L. G. Stead, W. W. Decker, L. N. Scanlan-Hanson, R. J. Lennon, C.-C. Lim, D. R. Holmes Jr, C. S. Rihal, et al. Sustaining Improvement in Door-to-Balloon Time Over 4 Years: The Mayo Clinic ST-Elevation Myocardial Infarction Protocol Circ Cardiovasc Qual Outcomes, September 1, 2009; 2(5): 508 - 513. [Abstract] [Full Text] [PDF]

				A. Halkin, D. Fourey, A. Roth, V. Boyko, and S. Behar Incidence and prognosis of non-Q-wave vs. Q-wave myocardial infarction following catheter-based reperfusion therapy QJM, June 1, 2009; 102(6): 401 - 406. [Abstract] [Full Text] [PDF]

				G. Guagliumi Emerging data and decision for optimizing STEMI management: the European perspective Eur. Heart J. Suppl., June 1, 2009; 11(suppl_C): C19 - C24. [Abstract] [Full Text] [PDF]

				M. A. Hlatky and P. A. Heidenreich The Year in Epidemiology, Health Services Research, and Outcomes Research J. Am. Coll. Cardiol., April 21, 2009; 53(16): 1459 - 1466. [Full Text] [PDF]

				S. V. Parikh, D. B. Treichler, S. DePaola, J. Sharpe, M. Valdes, T. Addo, S. R. Das, D. K. McGuire, J. A. de Lemos, E. C. Keeley, et al. Systems-Based Improvement in Door-to-Balloon Times at a Large Urban Teaching Hospital: A Follow-Up Study From Parkland Health and Hospital System Circ Cardiovasc Qual Outcomes, March 1, 2009; 2(2): 116 - 122. [Abstract] [Full Text] [PDF]

				P. M. Ho, P. N. Peterson, and F. A. Masoudi Evaluating the Evidence: Is There a Rigid Hierarchy? Circulation, October 14, 2008; 118(16): 1675 - 1684. [Full Text] [PDF]

				S. R. Dixon, C. L. Grines, and W. W. O'Neill The year in interventional cardiology. J. Am. Coll. Cardiol., June 17, 2008; 51(24): 2355 - 2369. [Full Text] [PDF]

				F. A. Masoudi Measuring the Quality of Primary PCI for ST-Segment Elevation Myocardial Infarction: Time for Balance JAMA, December 19, 2007; 298(23): 2790 - 2791. [Full Text] [PDF]

				Emergency Physician Activation of the Cardiac Cath Lab Journal Watch Emergency Medicine, August 17, 2007; 2007(817): 1 - 1. [Full Text]

				Improving Door-to-Balloon Time for Patients with ST-Segment-Elevation MI Journal Watch Cardiology, August 1, 2007; 2007(801): 1 - 1. [Full Text]

				J. P. Ornato The ST-Segment-Elevation Myocardial Infarction Chain of Survival Circulation, July 3, 2007; 116(1): 6 - 9. [Full Text] [PDF]