Abstract 2070: Where do Delays Occur in STEMI Patients Transferred for Primary Percutaneous Coronary Intervention?
INTRODUCTION: Recent trials have demonstrated that STEMI patients (pts) benefit from transfer for primary PCI compared to fibrinolysis. AHA/ACC guidelines recommend a door-to-balloon time of 90 minutes for STEMI pts receiving primary PCI. NRMI data indicate only 4% are treated < 90 minutes, and only 16% < 120 minutes. The reasons for delay have not been well studied.
METHODS: We developed a program for rapid transfer of STEMI pts for primary PCI. Detailed time data are recorded, with the 90 minute goal being broken down into three 30 minute segments: in-door out-door at the community hospital, transfer, and door-to-balloon at the PCI center. A specific reason for delay is recorded for each time segment if the delay is > 30 minutes. No pts are excluded from analysis, including cardiogenic shock, out of hospital cardiac arrest, and non-diagnostic initial EKG.
RESULTS: From 3/03 to 3/06, 471 pts were transferred from hospitals up to 60 miles away for primary PCI. Median times and percent at goal for each segment are reported in the Table⇓. Delays in the community hospital (in door 1-out door 1) were related to transport (40%), ED physician related delays (23.5%), diagnostic dilemmas (17%), non-diagnostic initial EKGs (12.4%), cardiac arrest (5.3%), and cardiogenic shock (1.8%). Delays during transfer were weather (62.5%) or traffic (37.5%) related. Delays at the PCI center (door-to-balloon) were due to complex procedures (71.8%), cath lab team delays (20.5%), diagnostic dilemmas (5.1%) or cardiac arrest (2.6%).
Conclusion: A standardized, organized transfer system significantly improves door-to-balloon times, with 81% of pts treated in < 120 min compared to the 16% < 120 min reported in NRMI. However, delays still occur. The most common reasons are waiting for transport and diagnostic dilemmas at the community hospital, weather and traffic during transfer, and complex procedures at the PCI hospital.