Abstract 10961: Factors Associated with Delays in Primary PCI and Cardiac Catheterization Laboratory Activation for ST-Segment Elevation Myocardial Infarctions; A Report From the Activate-SF Registry
Context: There is increasing autonomy among emergency physicians diagnosing patients with ST-segment Elevation Myocardial Infarctions (STEMIs). Little is known about the factors that influence the time required to establish this diagnosis.
Objective: To assess the role of time from hospital arrival to STEMI diagnosis (door-to-activation time), on door-to-balloon time in contemporary practice, and evaluate factors that influence door-to-activation times.
Design: Registry data on 407 patients diagnosed with a STEMI in the emergency department (ED) over 30 months at two urban primary PCI centers were analyzed using multivariate regression models. The primary outcome was time from hospital arrival to STEMI diagnosis by the emergency department physician.
Results: The median door-to-activation time was 21 minutes (IQR 9 - 57). Among components of the door-to-balloon time, variation in door-to-activation times explained 90.5% of the variation in door-to-balloon times and demonstrated the strongest correlation with door-to-balloon times (correlation coefficient 0.945, Figure). Factors significantly associated with door-to-activation time include: pre-hospital ECG use (63% shorter, 95%CI -50 to -72%, p <0.001) and CT scan use in the ED (202% longer, 95%CI +34 to +305%, p = 0.001). The consequent door-to-balloon times were 19% shorter (95%CI -8 to -29%, p = 0.001) and 83% longer (95%CI +46 to + 227%, p <0.001) respectively.
Conclusions: The majority of the variability in door-to-balloon times is the result of time spent establishing the diagnosis of a STEMI. Emphasis on clinical decision-making in the emergency department and routine pre-hospital ECG use, when available, are paramount to achieving consistently timely reperfusion.
- © 2011 by American Heart Association, Inc.