Abstract 15022: Using Heart Broken Index to Improve the Diagnostic Accuracy of Patient with ST elevation myocardial infarction and Shorten Door-to-Balloon Time on Emergency Room.
Background: Door-to-balloon (D2B) time is associated with mortality in patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction (STEMI). Any delay in door-to-balloon time in such patients is associated with an increased mortality. In our country, most of patient with STEMI were required triage in ER, but it depends on emergency physician's experience, especially in patients with atypical presentation (e.g. epigastralgia). So we needed a more effective and objective tools to assist ER triage.
Method: To pick up the patient with STEMI rapidly, we tried to design a more effective index. According to typical symptoms and literature review (Anderson JL et al. 2007), we defined those symptoms and established a table to classify patient with the risk, who came to our ER, that's Heart Broken Index(HBI)(Table 1.). We recommended the HBI to be used in ER: when the total score was more than 2, that patient would be sent to check ECG data immediately. In the meanwhile, routine triage without HBI was also permitted and we compared the diagnostic accuracy of these two groups (HBI group and routine triage).
Result: In this study, there were only 0.1% of patients with STEMI in our ER could be identified in our routine triage. When we used the HBI, diagnostic accuracy of patient with STEMI could be elevated to 2.5% (Figure 1.). The detection sensitivity of HBI (more than 2) to pick up the STEMI is 97%. Beside, before we used HBI, achieving rate of D2B time within 90 minutes was 61.6±16.2%. After HBI extensive used, D2B time within 90 minutes was up to 83.2±11.1% (p<0.01)(Figure 2.).
Conclusion: The introduction HBI could not only increase triage accuracy of STEMI, but also shorten D2B time.
- © 2011 by American Heart Association, Inc.