Abstract 3177: Do Hospitals that Improve “Direct Arrival” Door to Balloon Times for Primary Percutaneous Coronary Intervention Also Improve “Transfer In” Door to Balloon Times?
National initiatives have focused on reducing door to balloon (DTB) times for direct arrival STEMI patients undergoing primary PCI. However, the impact of these quality improvement endeavors on total DTB times for STEMI patients transferred from community to PCI hospitals has not been evaluated. We examined 25,476 transfer-in (32%) and 53,468 direct arrival STEMI patients who underwent primary PCI at 403 hospitals in the National Cardiovascular Data Registry from 2005–2007. DTB times for transfer-in patients were defined from arrival time at the 1st hospital to time of PCI. For each hospital, changes in annual geometric mean DTB time for transfer-in patients were correlated with changes in DTB time for direct arrival patients. Transfer-in patients were significantly less likely to receive primary PCI within 90 minutes of presentation compared with direct arrival patients (8.4 vs. 60.7%, p<0.0001). From 2005 to 2007, hospital mean DTB times decreased significantly for both direct arrival (from 93 to 72 min, p for trend <0.0001) and transfer-in patients (192 to 158 min, p<0.0001). However, there was no significant correlation between DTB time improvements in transfer-in and direct arrival patients at the hospital level (Figure⇓). While national DTB times have decreased significantly over time, <10% of transfer-in STEMI patients have DTB times <90 minutes. Moreover, hospitals with improved DTB times for direct arrival patients did not necessarily show improvement for transfer-in patients. These results emphasize the importance of system-wide strategies to reduce reperfusion delays for both transfer-in and direct arrival STEMI patients.