Clinical InvestigationInterventional CardiologyDirect ambulance admission to the cardiac catheterization laboratory significantly reduces door-to-balloon times in primary percutaneous coronary intervention☆
Section snippets
Setting
From April 2005, a 24/7 primary PCI service was established in a single large tertiary care interventional center with 6 catheterization laboratories and 7 interventional cardiologists, serving an urban population of 1.25 million across an established regional network including surrounding peripheral hospitals. Initially, all patients (ambulance admissions and self-presenters) were referred for primary PCI after presentation to the emergency room (ER) of either the PCI center or 2 referring
Results
Between April 1, 2005, and April 30, 2007, 622 cases of primary PCI were performed at our institution. Twenty-one cases were excluded from the analysis because their first ECG was nondiagnostic and ST-elevation occurred at a later stage making analysis of door-to-balloon and call-to balloon times inappropriate. Another 24 patients were excluded because they were referred from extrinsic sources (other referring hospital, STEMI as in-patient, peri-operative STEMI). The remaining 577 patients (63
Discussion
The principal finding of this study is that prehospital paramedic ECG diagnosis of STEMI and subsequent direct ambulance admission to the cardiac catheterization laboratory substantially reduce time to treatment in primary PCI, enabling almost all patients to be treated within the 90-minute target door-to-balloon time.
A number of investigators have demonstrated that prehospital ECG diagnosis reduces time-to-thrombolysis and as a result all-cause mortality in STEMI.12, 13, 14, 15, 16, 17
Conclusions
Prehospital paramedic ECG diagnosis of STEMI and subsequent direct ambulance admission to the cardiac catheterization laboratory dramatically reduces door-to-balloon times in primary PCI, enabling almost all patients to be treated within the 90-minute target. We believe this approach should be a key element of any contemporary primary PCI service.
Acknowledgements
The authors wish to thank Mandy Dudson, who helped with data input. We are also grateful to the database manager Peter Tooze, who provided excellent support throughout the project. Finally, we acknowledge the support of Chris Croden from the Yorkshire Ambulance Services.
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2015, International Journal of Cardiology
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This work was supported by a grant from the National Infarct Angioplasty Pilot project, Department of Health, UK.