Achieving routine sub 30 minute door-to-balloon times in a high volume 24/7 primary angioplasty center with autonomous ambulance diagnosis and immediate catheter laboratory access - 12/08/11
, Rajesh Kharbanda, MD, Gopal Ghimire, MD, Jon Spiro, MD, Phil Moore, MD, Michael Roughton, MSc, Rebecca Lane, MD, Mohammad Al-Obaidi, MD, Molly Teoh, MSc, Elizabeth Hutchison, MSc, Mark Whitbread, MSc, David Fountain, MSc, Richard Grocott-Mason, MD, Andrew Mitchell, MD, Mark Mason, MD, Charles Ilsley, MDRésumé |
Background |
In primary angioplasty (primary percutaneous coronary intervention [PPCI]) for acute myocardial infarction, institutional logistical delays can increase door-to-balloon times, resulting in increased mortality.
Methods |
We moved from a thrombolysis (TL) service to 24/7 PPCI for direct access and interhospital transfer in April 2004. Using autonomous ambulance diagnosis with open access to the myocardial infarction center catheter laboratory, we compared reperfusion times and clinical outcomes for the final 2 years of TL with the first 3 years of PPCI.
Results |
Comparison was made between TL (2002-2004, n = 185) and PPCI (2004-2007, n = 704); all times are medians in minutes (interquartile range): for TL, symptom to needle 153 (85-225), call to needle 58 (49-73), first professional contact (FPC) to needle 47 (39-63), door to needle 18 (12-30) (mortality: 7.6% at 30 days, 9.2% at 1 year); for interhospital transfer PPCI (n = 227), symptom to balloon 226 (175-350), call to balloon 135 (117-188), FPC to balloon 121 (102-166), first door-to-balloon 100 (80-142) (mortality: 7.0% at 30 days, 12.3% at 1 year); for direct-access PPCI (n = 477), symptom to balloon 142 (101-238), call to balloon 79 (70-93), FPC to balloon 69 (59-82), door to balloon 20 (16-29) (mortality: 4.6% at 30 days, 8.6% at 1 year). There was no difference between direct-access PPCI and TL times for symptom to needle/balloon. Direct-access PPCI was significantly quicker for the group than in-hospital thrombolysis for door to needle/balloon times due to the lack of any long wait patients (P < .001).
Conclusions |
Interhospital transfer remains slow even with rapid institutional door-to-balloon times. With autonomous ambulance diagnosis and open access direct to the catheter laboratory, a median door-to-balloon time of <30 minutes day and night was achieved, and >95% of patients were reperfused within 1 hour.
Le texte complet de cet article est disponible en PDF.Plan
Vol 158 - N° 5
P. 829-835 - novembre 2009 Retour au numéro
Article précédent
- Nephrotoxicity of iodixanol versus iopamidol in patients with chronic kidney disease and diabetes mellitus undergoing coronary angiographic procedures
- Warren Laskey, Peter Aspelin, Charles Davidson, Michael Rudnick, Pierre Aubry, Sreenivas Kumar, Frank Gietzen, Marcus Wiemer, on behalf of the DXV405 Study Group
- Incremental value of 2-dimensional speckle tracking strain imaging to wall motion analysis for detection of coronary artery disease in patients undergoing dobutamine stress echocardiography
- Arnold C.T. Ng, Marta Sitges, Phuong N. Pham, Da T. Tran, Victoria Delgado, Matteo Bertini, Gaetano Nucifora, Jane Vidaic, Christine Allman, Eduard R. Holman, Jeroen J. Bax, Dominic Y. Leung
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?