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"Code STEMI" protocol helps in achieving reduced door-to-balloon times in patients presenting with acute ST-segment elevation myocardial infarction during off-hours.
J Emerg Med. 2012 Mar; 42(3):260-6.JE

Abstract

BACKGROUND

Door-to-balloon (D2B) time is conceived as a crucial parameter for evaluating the quality of acute ST-segment elevation myocardial infarction (STEMI) care. Ideally, primary percutaneous intervention should be performed within 90 min of hospital arrival.

OBJECTIVES

We sought to determine the impact of emergency physician-activated "Code STEMI" protocol on door-to-balloon times during off-hours.

METHODS

Patients were divided into two study groups: one group consisted of 27 STEMI patients who presented during off-hours in the pre-Code STEMI period (January to December 2006) and the second group consisted of 60 STEMI patients admitted during off-hours when Code STEMI was fully operational (January 2007 to December 2008). The primary objective was to compare median D2B times in both the study groups. Secondary parameters of interest included the individual components of D2B time, peak serum troponin levels, peak creatine kinase total levels, all-cause in-hospital mortality, 6-month all-cause mortality, and 12-month all-cause mortality.

RESULTS

With the implementation of "Code STEMI" protocol, the median D2B time during off-hours dropped to 77 min (interquartile range [IQR] 67-95), representing a 52-min improvement (p = 0.0001). ECG-to-catheterization laboratory time demonstrated absolute reduction of 16 min. Median peak troponin-I levels dropped from 62 ng/mL (IQR 23-142) to 25 ng/mL (IQR 7-43; p < 0.002). No statistically significant differences were perceived in all-cause mortality among the study groups.

CONCLUSIONS

Implementation of "Code STEMI" protocol at our institution significantly reduced D2B times for STEMI during off-hours.

Authors+Show Affiliations

Department of Internal Medicine, St. Joseph's Regional Medical Center, Paterson, New Jersey 07503, 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

21536399

Citation

Bajaj, Sharad, et al. ""Code STEMI" Protocol Helps in Achieving Reduced Door-to-balloon Times in Patients Presenting With Acute ST-segment Elevation Myocardial Infarction During Off-hours." The Journal of Emergency Medicine, vol. 42, no. 3, 2012, pp. 260-6.
Bajaj S, Parikh R, Gupta N, et al. "Code STEMI" protocol helps in achieving reduced door-to-balloon times in patients presenting with acute ST-segment elevation myocardial infarction during off-hours. J Emerg Med. 2012;42(3):260-6.
Bajaj, S., Parikh, R., Gupta, N., Aldehneh, A., Rosenberg, M., Hamdan, A., & Bikkina, M. (2012). "Code STEMI" protocol helps in achieving reduced door-to-balloon times in patients presenting with acute ST-segment elevation myocardial infarction during off-hours. The Journal of Emergency Medicine, 42(3), 260-6. https://doi.org/10.1016/j.jemermed.2011.03.014
Bajaj S, et al. "Code STEMI" Protocol Helps in Achieving Reduced Door-to-balloon Times in Patients Presenting With Acute ST-segment Elevation Myocardial Infarction During Off-hours. J Emerg Med. 2012;42(3):260-6. PubMed PMID: 21536399.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - "Code STEMI" protocol helps in achieving reduced door-to-balloon times in patients presenting with acute ST-segment elevation myocardial infarction during off-hours. AU - Bajaj,Sharad, AU - Parikh,Rupen, AU - Gupta,Nishant, AU - Aldehneh,Anthony, AU - Rosenberg,Mark, AU - Hamdan,Aiman, AU - Bikkina,Mahesh, Y1 - 2011/05/04/ PY - 2010/06/01/received PY - 2010/08/14/revised PY - 2011/03/17/accepted PY - 2011/5/4/entrez PY - 2011/5/4/pubmed PY - 2012/6/8/medline SP - 260 EP - 6 JF - The Journal of emergency medicine JO - J Emerg Med VL - 42 IS - 3 N2 - BACKGROUND: Door-to-balloon (D2B) time is conceived as a crucial parameter for evaluating the quality of acute ST-segment elevation myocardial infarction (STEMI) care. Ideally, primary percutaneous intervention should be performed within 90 min of hospital arrival. OBJECTIVES: We sought to determine the impact of emergency physician-activated "Code STEMI" protocol on door-to-balloon times during off-hours. METHODS: Patients were divided into two study groups: one group consisted of 27 STEMI patients who presented during off-hours in the pre-Code STEMI period (January to December 2006) and the second group consisted of 60 STEMI patients admitted during off-hours when Code STEMI was fully operational (January 2007 to December 2008). The primary objective was to compare median D2B times in both the study groups. Secondary parameters of interest included the individual components of D2B time, peak serum troponin levels, peak creatine kinase total levels, all-cause in-hospital mortality, 6-month all-cause mortality, and 12-month all-cause mortality. RESULTS: With the implementation of "Code STEMI" protocol, the median D2B time during off-hours dropped to 77 min (interquartile range [IQR] 67-95), representing a 52-min improvement (p = 0.0001). ECG-to-catheterization laboratory time demonstrated absolute reduction of 16 min. Median peak troponin-I levels dropped from 62 ng/mL (IQR 23-142) to 25 ng/mL (IQR 7-43; p < 0.002). No statistically significant differences were perceived in all-cause mortality among the study groups. CONCLUSIONS: Implementation of "Code STEMI" protocol at our institution significantly reduced D2B times for STEMI during off-hours. SN - 0736-4679 UR - https://www.unboundmedicine.com/medline/citation/21536399/"Code_STEMI"_protocol_helps_in_achieving_reduced_door_to_balloon_times_in_patients_presenting_with_acute_ST_segment_elevation_myocardial_infarction_during_off_hours_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0736-4679(11)00289-7 DB - PRIME DP - Unbound Medicine ER -