Abstract 9897: Frequency of Non-Systems Delays in STEMI Patients Undergoing Primary PCI and Implications for Door-to-Balloon Time Reporting. A Report from The ACTION Registry®-GWTG™ and AHA
Introduction: Door to balloon (D2B) time ≤90 minutes (min), and percentage of primary PCI patients (pts) with a D2B ≤90 min are used as performance metrics by many organizations. Pts can be excluded from this measure if they have a non-systems related delay. However, how frequently exclusions occur, and how it affects the reporting of D2B times at the hospital level is unknown.
Methods: The percentage of pts having non-systems delays (cardiac arrest, intubation, difficult vascular access, etc) for primary PCI at the hospital level was calculated using data from the ACTION Registry®-GWTG™. Pts were excluded if the first ECG was not diagnostic, or were transferred to or from another hospital. Hospitals having < 36 primary PCIs during the study period were also excluded. Hospitals were categorized into three groups based on tertiles of percentage of excluded pts. The percentage of hospitals with a D2B ≤90 min in ≥90% of pts were calculated by first including and then excluding pts that had non-systems delays.
Results: From 1/1/07-3/31/11, 43,909 pts from 294 hospitals were included. The percentage of exclusions recorded differed substantially among hospitals, ranging from 0-68% of pts (median 9.2% [IQR 5.6%, 13.5%] with low tertile ≤7.1%, intermediate tertile 7.1% to 11.2% and high tertile ≥11.2%. Reasons for exclusion included vascular access difficulty (7.8%) cardiac arrest/intubation (38%) and PCI procedural difficulties (20%). There were no significant differences in hospital annual total MI, STEMI, or primary PCI volumes, or hospital bed size among the three groups. Including pts with non-systems delays significantly increased D2B times and decreased the proportion of pts achieving D2B ≤90 min as well as percentage of hospitals having ≥90% of STEMI pts with D2B ≤90 min (TABLE).
Discussion: The proportion of pts excluded from D2B reporting varies substantially among hospitals. This has an important impact on reported performance measures.
- Myocardial infarction, STEMI
- Percutaneous coronary intervention
- Interventional cardiology
- Quality improvement
- © 2012 by American Heart Association, Inc.