Abstract 14132: The Association of Volume of Patients Admitted with ST Elevation Myocardial Infarction, and the Proportion receiving Primary Percutaneous Coronary Intervention, with Time Delays and Mortality: The Myocardial Ischaemia National Audit Project (MINAP) 2004–7.
Aims: To study determinants of door-to-balloon (DTB) times for the primary PCI (pPCI) service for ST-elevation myocardial infarction (STEMI) in England and Wales between 2004 and 2007.
Methods and results: All 8,653 admissions with STEMI to acute hospitals in England and Wales that underwent primary PCI as recorded in the Myocardial Ischaemia National Audit Project (MINAP) 2004–7. We studied the impact of volume of STEMI (hospital volume) and the proportion of patients treated with pPCI (hospital proportion) on DTB times and on 30-day mortality and employed regression analysis to identify reasons for DTB time variations with a multilevel component to express hospital variation. The proportion of patients receiving pPCI increased from 5% in 2004 to 20% in 2007. There was a decrease in median DTB times from 84 minutes in 2004 to 61 minutes in 2007. Mean DTB times decreased as the number of pPCI procedures increased. The 30-day all cause mortality rate, 95% CI for hospitals that performed pPCI for less than 25% of STEMI patients was significantly higher than those that performed pPCI for greater than 75% (5.0%, 3.9% to 6.1% versus 2.7%, 2.0% to 3.5%). Time-of-day, year of admission, sex and diabetes significantly influenced DTB times. Hospital variation was evident by a hospital-level DTB time standard deviation of 12 minutes.
Conclusions: There was large variation in DTB times between the best and worst performing hospitals. Although patient-related factors impact upon DTB times, hospital-specific reperfusion strategies are key determinants of DTB times and early mortality rates.
- © 2010 by American Heart Association, Inc.