Prompt reperfusion treatment is essential for patients who have myocardial infarction
with ST-segment elevation. Guidelines recommend that the interval between arrival
at the hospital and intracoronary balloon inflation (door-to-balloon time) during
primary percutaneous coronary intervention should be 90 minutes or less. However,
few hospitals meet this objective. We sought to identify hospital strategies that
were significantly associated with a faster door-to-balloon time.
We surveyed 365 hospitals to determine whether each of 28 specific strategies was
in use. We used hierarchical generalized linear models and data on patients from the
Centers for Medicare and Medicaid Services to determine the association between hospital
strategies and the door-to-balloon time.
In multivariate analysis, six strategies were significantly associated with a faster
door-to-balloon time. These strategies included having emergency medicine physicians
activate the catheterization laboratory (mean reduction in door-to-balloon time, 8.2
minutes), having a single call to a central page operator activate the laboratory
(13.8 minutes), having the emergency department activate the catheterization laboratory
while the patient is en route to the hospital (15.4 minutes), expecting staff to arrive
in the catheterization laboratory within 20 minutes after being paged (vs. >30 minutes)
(19.3 minutes), having an attending cardiologist always on site (14.6 minutes), and
having staff in the emergency department and the catheterization laboratory use real-time
data feedback (8.6 minutes). Despite the effectiveness of these strategies, only a
minority of hospitals surveyed were using them.
Several specific hospital strategies are associated with a significant reduction in
the door-to-balloon time in the management of myocardial infarction with ST-segment
Copyright 2006 Massachusetts Medical Society.