Abstract 1062: Evaluation of Door-In-Door-Out Time as a Clinical Performance Measure for Patients Transferred for Primary Percutaneous Coronary Intervention
Background: Guidelines recommend a first door-to-balloon time ≤90 minutes (min) for patients with ST-elevation myocardial infarction (STEMI) transferred for primary percutaneous coronary intervention (PCI). Door-in-door-out time (DIDO) has been proposed as a clinical performance measure to assess patient care processes attributable to the transfer-out hospital, but little is known about its overall impact on the timeliness of reperfusion therapy.
Methods: We studied 7438 patients with STEMI, transferred for primary PCI, enrolled in the ACTION registry at 210 centers, from January 2007 to December 2008. Patients treated with fibrinolytic therapy and facilitated PCI were excluded. A total of 47 (0.6%) patients had a documented contraindication to fibrinolytic therapy. DIDO was defined as the duration of time from arrival to discharge at the first hospital. We evaluated how DIDO contributed to timeliness of reperfusion therapy as measured by door-out-to-balloon time and first door-to-balloon time.
Results: Mean age was 61.4 years and 70% were male. Median DIDO was 74 (45, 132) min and 747 (10%) patients had DIDO ≤30 min. For patients with DIDO ≤30 min, median first door-to-balloon time was 87 min as compared to 143 min (p<0.0001) for those with DIDO >30 min. Among patients with DIDO ≤30 min, 56% and 88% achieved first door-to-balloon times of ≤90 min and ≤120 min, respectively. Among patients with DIDO >30 min, 7% and 25% achieved first door-to-balloon times of ≤90 min and ≤120 min, respectively.
Conclusions: DIDO ≤30 min was achieved in only 10% of patients transferred for primary PCI. Patients with DIDO ≤30 min had significantly higher likelihood of achieving timely overall first door-to-balloon goals recommended by clinical guidelines. Strategies to improve DIDO should be pursued to improve the timeliness of reperfusion therapy for patients transferred for primary PCI.