Hospital Improvement in Time to Reperfusion in Patients With Acute Myocardial Infarction, 1999 to 2002

Yale University, New Haven, Connecticut, United States
Journal of the American College of Cardiology (Impact Factor: 15.34). 01/2006; 47(1):45-51. DOI: 10.1016/j.jacc.2005.04.071
Source: PubMed

ABSTRACT The purpose of this study was to analyze recent trends in door-to-reperfusion time and to identify hospital characteristics associated with improved performance.
Rapid reperfusion improves survival for patients with acute ST-segment elevation myocardial infarction (STEMI).
In this retrospective observational study from the National Registry of Myocardial Infarction (NRMI)-3 and -4, between 1999 and 2002, we analyzed door-to-needle and door-to-balloon times in patients admitted with STEMI and receiving fibrinolytic therapy (n = 68,439 patients in 1,015 hospitals) or percutaneous coronary intervention (n = 33,647 patients in 421 hospitals) within 6 h of hospital arrival.
In 1999, only 46% of the patients in the fibrinolytic therapy cohort were treated within the recommended 30-min door-to-needle time; only 35% of the patients in the percutaneous coronary intervention cohort were treated within the recommended 90-min door-to-balloon time. Improvement in these times to reperfusion over the four-year study period was not statistically significant (door-to-needle: -0.01 min/year, 95% confidence interval [CI] -0.24 to +0.23, p > 0.9; door-to-balloon: -0.57 min/year, 95% CI -1.24 to +0.10, p = 0.09). Only 33% (337 of 1,015) of hospitals improved door-to-needle time by more than one min/year, and 26% (110 of 421) improved door-to-balloon time by more than three min/year. No hospital characteristic was significantly associated with improvement in door-to-needle time. Only high annual percutaneous coronary intervention volume and location in New England were significantly associated with greater improvement in door-to-balloon time.
Fewer than one-half of patients with STEMI receive reperfusion in the recommended door-to-needle or door-to-balloon time, and mean time to reperfusion has not decreased significantly in recent years. Relatively few hospitals have shown substantial improvement.

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Available from: Jeph Herrin, Aug 27, 2015
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    • "DNT is the time taken from patient's arrival to a medical facility to the time when thrombolytic therapy is administered. As a result of the importance of the timing of the thrombolysis, DNT time has emerged as an important hospital performance measure for the quality of care of patients with STEMI in the United States and Europe [6] [7] [8]. The American College of Cardiology/the American Heart Association (ACC/AHA) and the European Society of Cardiology (ESC) guidelines for STEMI recommend that the DNT for thrombolysis should be within 30 minutes of first medical system contact [6] [7]. "
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    ABSTRACT: Objective. Early restoration of coronary perfusion by thrombolysis or percutaneous coronary intervention is the main modality of treatment to salvage the ischemic myocardium. The earlier the procedure is completed, the greater the benefit is in saving myocardium and restoring its functions. The aim of the study is to compare the door-to-needle time (DNT) in acute ST elevation myocardial infarction (STEMI) in the period prior to December 2008 when the site of thrombolysis was in coronary care unit (CCU) and the period after that when the site was shifted to emergency department (ED). Methods. A retrospective, descriptive study was conducted at Al Khor Hospital, Qatar, in patients with acute STEMI who underwent thrombolysis at CCU and ED from April 2005 until December 2011, to compare the DNT, duration of hospitalization, and mortality. Results. A total of 211 patients with acute STEMI were eligible for thrombolysis; 58 patients were thrombolysed in the CCU and 153 in ED. The median DNT was reduced from 33.5 minutes in the CCU to 17 minutes in the ED representing a reduction of more than 50% with a P value of < 0.0001. Conclusion. The transfer of the thrombolysis site from CCU to the ED was associated with a dramatic and significant reduction in median door-to-needle time by more than half.
    09/2013; 2013:208271. DOI:10.1155/2013/208271
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    Journal of the American College of Cardiology 05/2005; 45(7):1117-34. DOI:10.1016/j.jacc.2005.01.006 · 15.34 Impact Factor
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