Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-25T22:33:00.722Z Has data issue: false hasContentIssue false
  • English
  • Français

Impact of a rapid access protocol on decreasing door-to-balloon time in acute ST elevation myocardial infarction

Published online by Cambridge University Press:  21 May 2015

Jaelyn M. Caudle ,
Zoe Piggott ,
Suzanne Dostaler ,
Karen Graham  and
Robert J. Brison
Jaelyn M. Caudle*
Affiliation:
Department of Emergency Medicine, Queen's University, Kingston, Ont.
Zoe Piggott
Affiliation:
Department of Emergency Medicine, University of Manitoba, Winnipeg, Man.
Suzanne Dostaler
Affiliation:
Kingston General Hospital Clinical Research Centre, Kingston, Ont.
Karen Graham
Affiliation:
Department of Emergency Medicine, Queen's University, Kingston, Ont.
Robert J. Brison
Affiliation:
Department of Emergency Medicine, Queen's University, Kingston, Ont.
*
Department of Emergency Medicine, Queen's University, 79 Stuart St., Kingston ON K7L 2V7; [email protected]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

Ischemic cardiovascular disease is the leading cause of death in Canada. In ST elevation myocardial infarction (STEMI), time to reperfusion is a key determinant in reducing morbidity and mortality with percutaneous coronary intervention (PCI) being the preferred reperfusion strategy. Where PCI is available, delays to definitive care include times to electrocardiogram (ECG) diagnosis and cardiovascular laboratory access. In 2004, the Cardiac Care Network of Ontario recommended implementation of an emergency department (ED) protocol to reduce reperfusion time by transporting patients with STEMI directly to the nearest catheterization laboratory. The model was implemented in Frontenac County in April 2005. The objective of this study was to assess the effectiveness of a protocol for rapid access to PCI in reducing door-to-balloon times in STEMI.

Methods:

Two 1-year periods before and after implementation of a rapid access to PCI protocol (ending March 2005 and June 2006, respectively) were studied. Administrative databases were used to identify all subjects with STEMI who were transported by regional emergency medical services (EMS) and received emergent PCI. The primary outcome measure was time from ED arrival to first balloon inflation (door-to-balloon time). Times are presented as medians and interquartile ranges (IQRs). Statistical comparisons were made using the Mann–Whitney U test and presented graphically with Kaplan–Meier curves.

Results:

Patients transported under the rapid access protocol (n = 39) were compared with historical controls (n = 42). Median door-to-balloon time was reduced from 87 minutes (IQR 67–108) preprotocol to 62 minutes (IQR 40–80) postprotocol (p < 0.001).

Conclusion:

In our region, implementation of an EMS protocol for rapid access to PCI significantly reduced time to reperfusion for patients with STEMI.

Keywords

transfer protocolacute myocardial infarctionprehospital
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 11 , Issue 1 , January 2009 , pp. 29 - 35
Copyright
Copyright © Canadian Association of Emergency Physicians 2009

References

1.Heart and Stroke Foundation of Canada. Statistics. Ottawa (ON): The Foundation; 2008. Available: http://www.heartandstroke.on.ca/site/c.pvI3IeNWJwE/b.3581729/k.359A/Statistics.htm (accessed 2008 Nov 19).Google Scholar
2.Cannon, CP. Time to treatment of acute myocardial infarction revisited. Curr Opin Cardiol 1998;13:254–66.Google Scholar
3.De Luca, G, Suryapranata, H, Ottervanger, JP, et al.Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts. Circulation 2004;109:1223–5.Google Scholar
4.Sabatine, MS, O’Gara, PT, Lilly, LS. Chapter 7. In: Lilly, LS editor. Pathophysiology of heart disease. Baltimore (MD): Lippincott, Williams and Wilkins; 2003. p. 145–69.Google Scholar
5.Antman, EM, Anbe, DT, Armstrong, PW, et al.ACC/AHA guidelines for the management of patients with ST elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2004;110:e82-92.Google Scholar
6.Armstrong, PW, Bogaty, P, Buller, CE, et al.The 2004 ACC/AHA Guidelines: a perspective and adaptation for Canada by the Canadian Cardiovascular Society Working Group. Can J Cardiol 2004;20:1075–9.Google Scholar
7.Keeley, EC, Boura, JA, Grines, CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet 2003;361:13–20.CrossRefGoogle ScholarPubMed
8.McLellan, CS, LeMay, MR, Labinaz, M. Current reperfusion strategies for ST elevation myocardial infarction: a Canadian perspective. Can J Cardiol 2004;20:525–33.Google Scholar
9.Bonnefoy, E, Lapostolle, F, Leizorovicz, A, et al.Primary angioplasty versus prehospital fibrinolysis in acute myocardial infarction: a randomized study (CAPTIM). Lancet 2002;360:825–9.Google Scholar
10.Andersen, HR, Nielsen, TT, Rasmussen, K, et al.A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction. N Engl J Med 2003;349:733–42.CrossRefGoogle ScholarPubMed
11.Luepker, RV, Paczynki, JM, Osganian, S, et al.Effect of a community intervention on patient delay and emergency medical service use in acute coronary heart disease: the Rapid Early Action for Coronary Treatment (REACT) trial. JAMA 2000; 284:60–7.Google Scholar
12.Blohm, M, Herlitz, J, Hartford, M, et al.Consequences of a media campaign focusing on delay in acute myocardial infarction. Am J Cardiol 1992;69:411–3.Google Scholar
13.Canto, JG, Rogers, WJ, Bowlby, LJ, et al.for the National Registry of Myocardial Infarction 2 Investigators. The prehospital electrocardiogram in acute myocardial infarction: Is the full potential being realized? J Am Coll Cardiol 1997;29:498–505.Google Scholar
14.Morrison, LJ, Brooks, S, Sawadsky, B, et al.Prehospital 12-lead electrocardiography impact on acute myocardial infarction treatment times and mortality: a systematic review. Acad Emerg Med 2005;13:84–9.Google ScholarPubMed
15.Whitbread, M, Leah, V, Bell, T, et al.Recognition of ST elevation by paramedics. Emerg Med J 2002;19:66–7.Google Scholar
16.Bradley, EH, Herrin, J, Wang, Y, et al.Strategies for reducing the door-to-balloon time in acute myocardial infarction. N Engl J Med 2006;355:1–13.CrossRefGoogle ScholarPubMed
17.Leung, RC, Lundberg, DL, Rollefstad, T, et al.From 911 to balloon: reduction of ischemic time in primary angioplasty by implementation of an expedited transfer pathway. CJEM 2005;7:183.Google Scholar
18.Daly, PA. Management of STEMI in Canada: a report from Macstrak 1994–2006. Proceedings of the International Conference on Emergency Medicine; 2006 June 3–7; Halifax (NS): International Federation for Emergency Medicine; 2006.Google Scholar
19.Keeley, EC, Hills, LD. Primary PCI for myocardial infarction with ST-segment elevation. N Engl J Med 2007;356:47–54.Google Scholar
20.Bradley, EH, Herring, J, Wang, Y, et al.Strategies for reducing the door-to-balloon time in acute myocardial infarction. N Engl J Med 2006;355:2308–20.Google Scholar
21.Lemay, M, Dionne, R, Davies, RF, et al.Lower mortality in patients with ST-elevation myocardial infarction triaged in the field and referred for primary percutaneous angioplasty by advanced care paramedics. CJEM 2006;8:182.Google Scholar
22.Hancin, B. Trauma approach slices STEMI treatment time. ACEP News 2006;25:1–2.Google Scholar
23.de Villiers, JS, Anderson, T, McMeekin, JD, et al.Expedited transfer for primary percutaneous coronary intervention: a program evaluation. CMAJ 2007;176:1833–8.CrossRefGoogle ScholarPubMed