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Direct ambulance admission to the cardiac catheterization laboratory significantly reduces door-to-balloon times in primary percutaneous coronary intervention.
Am Heart J. 2008 Jun; 155(6):1054-8.AH

Abstract

BACKGROUND

Primary percutaneous coronary intervention (PCI) is the preferred treatment for ST-segment elevation myocardial infarction (STEMI) provided it can be delivered within 90 minutes of hospital admission. In clinical practice this target is difficult to achieve. We aimed to determine the effect of direct ambulance admission to the cardiac catheterization laboratory on door-to-balloon and call-to-balloon times in primary PCI.

METHODS

We performed a prospective evaluation of a new system of paramedic electrocardiogram diagnosis of STEMI and subsequent direct ambulance admission to the cardiac catheterization laboratory for primary PCI. Door-to-balloon and call-to-balloon times were recorded for all patients. Direct admissions were compared with admissions via the emergency room of the interventional center and of 2 referring hospitals. All times are quoted as medians.

RESULTS

Five hundred and seventy-seven patients (70% male, age 63 +/- 13 years) underwent primary PCI between April 2005 and May 2007. After February 2006, 172 (44%) of 387 patients were admitted directly from the ambulance to the catheterization laboratory. Directly admitted patients had significantly reduced door-to-balloon (58 vs 105 minutes, P < .001) and call-to-balloon times (105 vs 143 minutes, P < .001). The 90-minute target for door-to-balloon time was achieved in 94% of direct admissions compared to 29% of patients referred from the emergency room.

CONCLUSIONS

Direct admission of patients with suspected STEMI from the ambulance service to the catheterization laboratory significantly reduces time to treatment in primary PCI and allows the 90-minute door-to-balloon time target to be reliably achieved.

Authors+Show Affiliations

Department of Cardiology, Leeds General Infirmary, Leeds, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18513519

Citation

Dorsch, Michael F., et al. "Direct Ambulance Admission to the Cardiac Catheterization Laboratory Significantly Reduces Door-to-balloon Times in Primary Percutaneous Coronary Intervention." American Heart Journal, vol. 155, no. 6, 2008, pp. 1054-8.
Dorsch MF, Greenwood JP, Priestley C, et al. Direct ambulance admission to the cardiac catheterization laboratory significantly reduces door-to-balloon times in primary percutaneous coronary intervention. Am Heart J. 2008;155(6):1054-8.
Dorsch, M. F., Greenwood, J. P., Priestley, C., Somers, K., Hague, C., Blaxill, J. M., Wheatcroft, S. B., Mackintosh, A. F., McLenachan, J. M., & Blackman, D. J. (2008). Direct ambulance admission to the cardiac catheterization laboratory significantly reduces door-to-balloon times in primary percutaneous coronary intervention. American Heart Journal, 155(6), 1054-8. https://doi.org/10.1016/j.ahj.2008.01.014
Dorsch MF, et al. Direct Ambulance Admission to the Cardiac Catheterization Laboratory Significantly Reduces Door-to-balloon Times in Primary Percutaneous Coronary Intervention. Am Heart J. 2008;155(6):1054-8. PubMed PMID: 18513519.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Direct ambulance admission to the cardiac catheterization laboratory significantly reduces door-to-balloon times in primary percutaneous coronary intervention. AU - Dorsch,Michael F, AU - Greenwood,John P, AU - Priestley,Claire, AU - Somers,Kathryn, AU - Hague,Carole, AU - Blaxill,Jonathan M, AU - Wheatcroft,Stephen B, AU - Mackintosh,Alan F, AU - McLenachan,James M, AU - Blackman,Daniel J, Y1 - 2008/03/05/ PY - 2007/10/26/received PY - 2008/01/19/accepted PY - 2008/6/3/pubmed PY - 2008/6/20/medline PY - 2008/6/3/entrez SP - 1054 EP - 8 JF - American heart journal JO - Am Heart J VL - 155 IS - 6 N2 - BACKGROUND: Primary percutaneous coronary intervention (PCI) is the preferred treatment for ST-segment elevation myocardial infarction (STEMI) provided it can be delivered within 90 minutes of hospital admission. In clinical practice this target is difficult to achieve. We aimed to determine the effect of direct ambulance admission to the cardiac catheterization laboratory on door-to-balloon and call-to-balloon times in primary PCI. METHODS: We performed a prospective evaluation of a new system of paramedic electrocardiogram diagnosis of STEMI and subsequent direct ambulance admission to the cardiac catheterization laboratory for primary PCI. Door-to-balloon and call-to-balloon times were recorded for all patients. Direct admissions were compared with admissions via the emergency room of the interventional center and of 2 referring hospitals. All times are quoted as medians. RESULTS: Five hundred and seventy-seven patients (70% male, age 63 +/- 13 years) underwent primary PCI between April 2005 and May 2007. After February 2006, 172 (44%) of 387 patients were admitted directly from the ambulance to the catheterization laboratory. Directly admitted patients had significantly reduced door-to-balloon (58 vs 105 minutes, P < .001) and call-to-balloon times (105 vs 143 minutes, P < .001). The 90-minute target for door-to-balloon time was achieved in 94% of direct admissions compared to 29% of patients referred from the emergency room. CONCLUSIONS: Direct admission of patients with suspected STEMI from the ambulance service to the catheterization laboratory significantly reduces time to treatment in primary PCI and allows the 90-minute door-to-balloon time target to be reliably achieved. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/18513519/Direct_ambulance_admission_to_the_cardiac_catheterization_laboratory_significantly_reduces_door_to_balloon_times_in_primary_percutaneous_coronary_intervention_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(08)00060-4 DB - PRIME DP - Unbound Medicine ER -