Abstract 3838: Reduced Contact-to-Balloon Time in ST Elevation Myocardial Infarction as a Consequence of Formalized Data Analysis and Feedback: One-Year Results of the German Multicenter FITT-STEMI-Trial
Background: Formalized data feedback is one strategy proposed to reduce treatment time in ST elevation myocardial infarction (STEMI). We evaluated the effect of systematic data analysis and feedback on contact-to-balloon time and on components of treatment time in a multicenter trial (Feedback Intervention and Treatment Times; FITT-STEMI, ClinicalTrials NCT00794001).
Methods: Consecutive unselected patients presenting with STEMI over a one-year period were prospectively enrolled (n=959). Participants were 6 hospitals with primary percutaneous coronary intervention (PCI) capacity and 29 cooperating non-PCI-hospitals. Protocols were in place to ensure prompt transfer of patients with STEMI to the PCI centers and to minimize time to treatment. They included obtaining pre-hospital 12-lead ECGs, bypassing non-PCI hospitals, and bypassing the emergency room with direct transfer to the cardiac catheterization laboratory (CCL) when feasible. No changes were made to these treatment protocols during the study period. At each PCI-hospital - and on a quarterly basis - data on time to treatment and its components, from initial patient contact to balloon inflation, were collected, presented to, and discussed with staff involved in the initial evaluation, transfer, and treatment of the patients. Comparisons between quarters were made with the Gehan and Pearson χ2 tests.
Results: The longest transport distance was 53 miles, and the longest transport time was 66 min. Mean (median) contact-to-balloon times decreased from 165 (129) min during the first quarter to 139 (115), 135 (107), and 130 (106) min during the next 3 quarters (p=0.0003). Door-to-balloon times decreased from 89 (70) minutes during the first quarter to 60 (50) min during the 4th quarter (p=0.000001). Significant reductions were observed in the time between arrival at the PCI center and arrival in the CCL (mean 53 to 29 min. p=0.000007), and in the time from puncture to balloon inflation (mean 25 to 21 min., p=0.0032). There was a nonsignificant decrease in mortality from 11.0% in the first quarter to 10.9%, 8.4%, and 8.8% in the next three quarters (p=0.41).
Conclusion: Formalized data feedback is associated with a marked reduction in treatment times for STEMI. This may result in a decrease in mortality.