Tags

Type your tag names separated by a space and hit enter

Impact of door-to-activation time on door-to-balloon time in primary percutaneous coronary intervention for ST-segment elevation myocardial infarctions: a report from the Activate-SF registry.
Circ Cardiovasc Qual Outcomes. 2012 Sep 01; 5(5):672-9.CC

Abstract

BACKGROUND

Little is known about the components of door-to-balloon time among patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. We assessed the role of time from hospital arrival to ST-segment elevation myocardial infarction diagnosis (door-to-activation time) on door-to-balloon time in contemporary practice and evaluated factors that influence door-to-activation times.

METHODS AND RESULTS

Registry data on 347 consecutive patients diagnosed with a ST-segment elevation myocardial infarction in the emergency department over 30 months at 2 urban primary percutaneous coronary intervention centers were analyzed. The primary study end point was the time from hospital arrival to catheterization laboratory activation by the emergency department physician, and we assessed factors associated with this period. Door-to-balloon time and its other components were secondary study end points. The median door-to-activation time was 19 minutes (interquartile range, 9-54). Variation in door-to-activation times explained 93% of the variation in door-to-balloon times and demonstrated the strongest correlation with door-to-balloon times (r=0.97). Achieving a door-to-activation time of ≤20 minutes resulted in an 89% chance of achieving a door-to-balloon time of ≤90 minutes compared with only 28% for patients with a door-to-activation time >20 minutes. Factors significantly associated with door-to-activation time include the following: prehospital ECG use (61% shorter, 95% confidence interval, -50 to -72%; P<0.001) and computed tomography scan use in the emergency department (245% longer, 95% confidence interval, +50 to +399%; P=0.001).

CONCLUSIONS

The interval from hospital arrival to ST-segment elevation myocardial infarction diagnosis and catheterization laboratory activation (door-to-activation time) is a strong driver of overall door-to-balloon times. Achieving a door-to-activation time ≤20 minutes was key to achieving a door-to-balloon time ≤90 minutes. Delays in door-to-activation time are not associated with delays in other aspects of the primary percutaneous coronary intervention process.

Authors+Show Affiliations

Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA 02115, USA. mccabe@aya.yale.eduNo 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)

Journal Article
Multicenter Study

Language

eng

PubMed ID

22949494

Citation

McCabe, James M., et al. "Impact of Door-to-activation Time On Door-to-balloon Time in Primary Percutaneous Coronary Intervention for ST-segment Elevation Myocardial Infarctions: a Report From the Activate-SF Registry." Circulation. Cardiovascular Quality and Outcomes, vol. 5, no. 5, 2012, pp. 672-9.
McCabe JM, Armstrong EJ, Hoffmayer KS, et al. Impact of door-to-activation time on door-to-balloon time in primary percutaneous coronary intervention for ST-segment elevation myocardial infarctions: a report from the Activate-SF registry. Circ Cardiovasc Qual Outcomes. 2012;5(5):672-9.
McCabe, J. M., Armstrong, E. J., Hoffmayer, K. S., Bhave, P. D., MacGregor, J. S., Hsue, P., Stein, J. C., Kinlay, S., & Ganz, P. (2012). Impact of door-to-activation time on door-to-balloon time in primary percutaneous coronary intervention for ST-segment elevation myocardial infarctions: a report from the Activate-SF registry. Circulation. Cardiovascular Quality and Outcomes, 5(5), 672-9.
McCabe JM, et al. Impact of Door-to-activation Time On Door-to-balloon Time in Primary Percutaneous Coronary Intervention for ST-segment Elevation Myocardial Infarctions: a Report From the Activate-SF Registry. Circ Cardiovasc Qual Outcomes. 2012 Sep 1;5(5):672-9. PubMed PMID: 22949494.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of door-to-activation time on door-to-balloon time in primary percutaneous coronary intervention for ST-segment elevation myocardial infarctions: a report from the Activate-SF registry. AU - McCabe,James M, AU - Armstrong,Ehrin J, AU - Hoffmayer,Kurt S, AU - Bhave,Prashant D, AU - MacGregor,John S, AU - Hsue,Priscilla, AU - Stein,John C, AU - Kinlay,Scott, AU - Ganz,Peter, Y1 - 2012/09/04/ PY - 2012/9/6/entrez PY - 2012/9/6/pubmed PY - 2012/12/15/medline SP - 672 EP - 9 JF - Circulation. Cardiovascular quality and outcomes JO - Circ Cardiovasc Qual Outcomes VL - 5 IS - 5 N2 - BACKGROUND: Little is known about the components of door-to-balloon time among patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. We assessed the role of time from hospital arrival to ST-segment elevation myocardial infarction diagnosis (door-to-activation time) on door-to-balloon time in contemporary practice and evaluated factors that influence door-to-activation times. METHODS AND RESULTS: Registry data on 347 consecutive patients diagnosed with a ST-segment elevation myocardial infarction in the emergency department over 30 months at 2 urban primary percutaneous coronary intervention centers were analyzed. The primary study end point was the time from hospital arrival to catheterization laboratory activation by the emergency department physician, and we assessed factors associated with this period. Door-to-balloon time and its other components were secondary study end points. The median door-to-activation time was 19 minutes (interquartile range, 9-54). Variation in door-to-activation times explained 93% of the variation in door-to-balloon times and demonstrated the strongest correlation with door-to-balloon times (r=0.97). Achieving a door-to-activation time of ≤20 minutes resulted in an 89% chance of achieving a door-to-balloon time of ≤90 minutes compared with only 28% for patients with a door-to-activation time >20 minutes. Factors significantly associated with door-to-activation time include the following: prehospital ECG use (61% shorter, 95% confidence interval, -50 to -72%; P<0.001) and computed tomography scan use in the emergency department (245% longer, 95% confidence interval, +50 to +399%; P=0.001). CONCLUSIONS: The interval from hospital arrival to ST-segment elevation myocardial infarction diagnosis and catheterization laboratory activation (door-to-activation time) is a strong driver of overall door-to-balloon times. Achieving a door-to-activation time ≤20 minutes was key to achieving a door-to-balloon time ≤90 minutes. Delays in door-to-activation time are not associated with delays in other aspects of the primary percutaneous coronary intervention process. SN - 1941-7705 UR - https://www.unboundmedicine.com/medline/citation/22949494/Impact_of_door_to_activation_time_on_door_to_balloon_time_in_primary_percutaneous_coronary_intervention_for_ST_segment_elevation_myocardial_infarctions:_a_report_from_the_Activate_SF_registry_ L2 - https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.112.966382?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -