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An emergency physician activated protocol, 'Code STEMI' reduces door-to-balloon time and length of stay of patients presenting with ST-segment elevation myocardial infarction.
Int J Clin Pract. 2009 Mar; 63(3):398-406.IJ

Abstract

INTRODUCTION

National consensus guidelines recommend that ST-segment elevation myocardial infarction (STEMI) patients achieve a door-to-balloon time of < 90 min. We sought to determine if emergency physician initiated simultaneous activation of the cardiac catheterisation laboratory team and the on-call interventional cardiologist has any impact on reducing door-to-balloon-times at our hospital.

METHODS

A total of 72 consecutive STEMI patients were evaluated from January 2007 to December 2007. The emergency physician activated Code STEMI required concurrent activation of cardiac catheterisation personnel and the on-call interventional cardiologist by the emergency physician. These patients were compared with our staff cardiologist activated primary angioplasty protocol from January 2006 to December 2006 for 51 consecutive STEMI patients. The primary outcome was to measure median door-to-balloon time between both groups. Secondary end-points included the individual components of door-to-balloon times (i.e. door-to-ECG time), peak troponin-I level within 24 h, length of stay and all-cause in-hospital mortality.

RESULTS

Median door-to-balloon time decreased overall (112 vs. 74 min, p < 0.001). Of the three components of door-to-balloon time analysed, the ECG to cardiac catheterization laboratory time exhibited the largest area of improvement with 16 min absolute reduction in median door-to-balloon time. Median peak troponin levels (50 vs. 25 ng/ml, p < 0.001), and hospital length of stay (4 vs. 3 days, p < 0.01) decreased. We did not see any statistically significant difference in all-cause in-hospital mortality (p = 0.6).

CONCLUSIONS

Emergency physician activation of the Code STEMI significantly reduces door-to-balloon time to within national standards of care, and length of stay in STEMI patients.

Authors+Show Affiliations

Department of Cardiology, St. Joseph's Regional Medical Center, Paterson, NJ 07501, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19222625

Citation

Parikh, R, et al. "An Emergency Physician Activated Protocol, 'Code STEMI' Reduces Door-to-balloon Time and Length of Stay of Patients Presenting With ST-segment Elevation Myocardial Infarction." International Journal of Clinical Practice, vol. 63, no. 3, 2009, pp. 398-406.
Parikh R, Faillace R, Hamdan A, et al. An emergency physician activated protocol, 'Code STEMI' reduces door-to-balloon time and length of stay of patients presenting with ST-segment elevation myocardial infarction. Int J Clin Pract. 2009;63(3):398-406.
Parikh, R., Faillace, R., Hamdan, A., Adinaro, D., Pruden, J., DeBari, V., & Bikkina, M. (2009). An emergency physician activated protocol, 'Code STEMI' reduces door-to-balloon time and length of stay of patients presenting with ST-segment elevation myocardial infarction. International Journal of Clinical Practice, 63(3), 398-406. https://doi.org/10.1111/j.1742-1241.2008.01920.x
Parikh R, et al. An Emergency Physician Activated Protocol, 'Code STEMI' Reduces Door-to-balloon Time and Length of Stay of Patients Presenting With ST-segment Elevation Myocardial Infarction. Int J Clin Pract. 2009;63(3):398-406. PubMed PMID: 19222625.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An emergency physician activated protocol, 'Code STEMI' reduces door-to-balloon time and length of stay of patients presenting with ST-segment elevation myocardial infarction. AU - Parikh,R, AU - Faillace,R, AU - Hamdan,A, AU - Adinaro,D, AU - Pruden,J, AU - DeBari,V, AU - Bikkina,M, PY - 2009/2/19/entrez PY - 2009/2/19/pubmed PY - 2009/5/12/medline SP - 398 EP - 406 JF - International journal of clinical practice JO - Int. J. Clin. Pract. VL - 63 IS - 3 N2 - INTRODUCTION: National consensus guidelines recommend that ST-segment elevation myocardial infarction (STEMI) patients achieve a door-to-balloon time of < 90 min. We sought to determine if emergency physician initiated simultaneous activation of the cardiac catheterisation laboratory team and the on-call interventional cardiologist has any impact on reducing door-to-balloon-times at our hospital. METHODS: A total of 72 consecutive STEMI patients were evaluated from January 2007 to December 2007. The emergency physician activated Code STEMI required concurrent activation of cardiac catheterisation personnel and the on-call interventional cardiologist by the emergency physician. These patients were compared with our staff cardiologist activated primary angioplasty protocol from January 2006 to December 2006 for 51 consecutive STEMI patients. The primary outcome was to measure median door-to-balloon time between both groups. Secondary end-points included the individual components of door-to-balloon times (i.e. door-to-ECG time), peak troponin-I level within 24 h, length of stay and all-cause in-hospital mortality. RESULTS: Median door-to-balloon time decreased overall (112 vs. 74 min, p < 0.001). Of the three components of door-to-balloon time analysed, the ECG to cardiac catheterization laboratory time exhibited the largest area of improvement with 16 min absolute reduction in median door-to-balloon time. Median peak troponin levels (50 vs. 25 ng/ml, p < 0.001), and hospital length of stay (4 vs. 3 days, p < 0.01) decreased. We did not see any statistically significant difference in all-cause in-hospital mortality (p = 0.6). CONCLUSIONS: Emergency physician activation of the Code STEMI significantly reduces door-to-balloon time to within national standards of care, and length of stay in STEMI patients. SN - 1742-1241 UR - https://www.unboundmedicine.com/medline/citation/19222625/An_emergency_physician_activated_protocol_'Code_STEMI'_reduces_door_to_balloon_time_and_length_of_stay_of_patients_presenting_with_ST_segment_elevation_myocardial_infarction_ L2 - https://doi.org/10.1111/j.1742-1241.2008.01920.x DB - PRIME DP - Unbound Medicine ER -