Abstract 3661: Direct Ambulance Admissions to the Catheter Laboratory Dramatically Reduce Door-to-Balloon and Call-to-Balloon Times in Primary Angioplasty
INTRODUCTION ACC/AHA guidelines recommend that primary PCI is the preferred treatment strategy for STEMI if it can be delivered within 90 minutes of admission to hospital. In clinical practice this 90 minute target can be difficult to achieve. Registry data comparing hospitals with and without a direct admissions policy suggest that Door-to-Balloon times could be reduced by receiving direct admissions from ambulance crews to the cardiac catheter laboratory. However, this has not been prospectively evaluated.
METHODS Since 1st April 2005 our large surgical centre has provided a 24/7 primary PCI service for a population of 800,000. From 1st April 2005 to 31st January 2006 all patients were admitted first to our emergency room department. After training of paramedic crews in ECG interpretation we accepted direct ambulance admissions commencing 1st February 2006. Call-to-Balloon and Door-to-Balloon were recorded for all patients. All quoted times are medians.
RESULTS From 1st April 2005 to 30st April 2006 we treated 258 patients (68% male, mean age 63 years) with primary PCI. Since introduction of our direct admission policy 40% of our patients (n=32) have been admitted immediately to the cardiac catheter lab. Since inception of the direct admission policy we have achieved the 90 minutes door to balloon time target in all 3 consecutive months, whereas we failed to do so in the preceeding 10 months. Median Door-to-Balloon times were significantly shorter for direct admissions (66 minutes) than for admissions via the emergency room (100 minutes, p<0.005). Direct admissions also have shorter Call-to-Balloon times (107 minutes) than emergency room patients (141 minutes, p<0.001). All patients referred directly by the ambulance services were judged to have possible STEMI by the attending interventional cardiologist and underwent immediate coronary angiography.
CONCLUSIONS Direct admission of patients with suspected STEMI from the ambulance service to the catheter laboratory are feasible and significantly reduce Door-to-Balloon and Call-to-Balloon times. In this small prospective series none of the direct admissions were considered inappropiate by the interventional cardiologist, suggesting that ambulance crews can reliably diagnose STEMI.