For many patients with ST-segment elevation myocardial infarctions (STEMIs), the time
from presentation to percutaneous coronary intervention exceeds established goals.
This study was conducted to examine the effects of formalized data assessment and
systematic feedback on treatment times. All patients with STEMIs treated with percutaneous
coronary intervention in a semirural 3-hospital network from January 1, 2006, to December
31, 2006, were prospectively analyzed (n = 114). Patients presenting during the first
3-month period (January 1, 2006, to March 31, 2006) were included as the reference
group (n = 33). Time points from initial contact with the medical system to revascularization
were assessed, analyzed, and presented in an interactive session to hospital and emergency
services staff members. Data from patients with STEMIs presenting during the next
3 quarters were presented in the same manner (n = 28, 25, and 28). The median contact-to-balloon
time was 113 minutes in the reference quarter, decreasing to 83, 66, and 74 minutes
in the intervention groups (p <0.0001), whereas the median door-to-balloon time decreased
from 54 minutes in the reference group to 35, 31, and 26 minutes in the intervention
groups (p <0.0001). The proportion of patients with contact-to-balloon times <90 minutes
increased from 21% to 79% (p <0.0001). There were significant reductions in the durations
of initial treatment on location and in the emergency room and in puncture-to-balloon-time
in the catheterization laboratory, and more patients were transported directly to
the catheterization laboratory, bypassing the emergency room (from 23% in the reference
quarter to 76% in the last intervention quarter, p <0.0001). In conclusion, formalized
data feedback leads to marked reduction in revascularization times in patients with
STEMIs.
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Article info
Publication history
Published online: November 16, 2007
Accepted:
July 13,
2007
Received in revised form:
July 13,
2007
Received:
May 30,
2007
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
