SHA24/057002

Improvement in door to balloon time at king abdulaziz Cardiac center : are we achieving the goal?

Ali Alghamdi, Mohammed Balgaith, Kamal Ayoub, Basil Saeed, Ahmed Sailik, Muyed Alzaibag

Disclosures The authors have no conflict to disclose

Introduction

Primary Percutaneous Coronary Intervention (PCI) is The treatment of choice for STEMI patients presenting to a hospital with PCI capability. (ACC/AHA class 1A) The effectiveness of primary percutaneous coronary intervention (PCI) is highly dependent on its timeliness. Clinical practice guidelines recommend that, the door to balloon time (D2B) should not exceed 90 minutes.

Primary PCI in STEMI.

O’Gara P T et al. Circulation 2013;127:529-555

Copyright © American Heart Association

Methods Create and implement a strategy that provides an integrated approach to the treatment of acute STEMI by forming a health-care team: Physicians – ED and Cardiology. Nursing – ED, Cardiac Cath Lab. Hospital transportation. Admitting.

Methods

Methods ď‚™ ER protocol for STEMI:

Insertion of 2 IV lines Aspirin 300 mgs Clopidogrel 600 mgs Heparin 4000 U IV

Methods  536 patients underwent primary PCI for STEMI from September 3, 2008 - Sept 30, 2012.  For each patient, the initial presenting time , the first ECG time, the time ER physician saw the patient and activate the cath lab, the time patient arrived to cath lab, and puncture time to balloon inflation were recorded.  52 patients were excluded from the study for not having clear door to balloon time.

Patient characteristics Age, years, mean + SD

54 + 12.5

Male, n (%)

430 (88.8)

BMI, mean + SD

28.3 + 4.8

DM, n (%)

205 (42.3)

HTN, n (%)

182 (37.6)

Hyperlipidemia, n (%)

149 (30.8)

Smoker, n (%) Anterior STEMI, n (%)

251 (51.9) 391 (80.7)

Results Door-to-Balloon Times D2B time, minutes

87 + 35.4

D2B time < 60 minutes, n (%) D2B time > 90 minutes D2B time < 90 minutes D2B time < 90 minutes , 2008-2009 D2B time < 90 minutes , 2010 D2B time < 90 minutes , 2011 D2B time < 90 minutes , 2012

79 (16.3) 184 (37.9) 300 (62.1) 57 (50.9) 74 (58.3) 61 (64.2) 108 (86)

Improvement in Door-toBalloon Time

Results

D2B time < 60 minutes

Results

D2B time during and after working hours

Conclusion  The study demonstrates the institution progress in decreasing D2B time.  Mean D2B times decreased substantially from 103 to 69 minutes.  Despite this improvement, additional opportunities for more improvement remain.  Achieving D2B times below 60 minutes, should be the future plan.

Conclusion

ď&#x201A;&#x2122;The improvement was achieved by collaboration among health care providers at KAMC.

Thanks