In‐hospital ‘CODE STEMI’ improves door‐to‐balloon time in patients undergoing primary percutaneous coronary intervention
- 12 September 2017
- journal article
- research article
- Published by Wiley in Emergency Medicine Australasia
- Vol. 30 (2), 222-227
- https://doi.org/10.1111/1742-6723.12855
Abstract
Reducing time to reperfusion for ST-segment elevation myocardial infarction (STEMI) is essential in improving outcomes. Consequently, numerous strategies have been employed to reduce median door-to-balloon time (DTBT). CODE STEMI is an ED physician-activated STEMI notification system. On activation, an announcement is made over the hospital's public announcement (PA) system. We prospectively analysed all in-hours STEMI patients who had primary percutaneous coronary intervention (PPCI) Pre-CODE STEMI (2014) and after CODE STEMI was implemented (2015). The primary end-points were median DTBT and the proportion of STEMI patients achieving a DTBT ≤90 min. The secondary end-points were in-hospital outcomes, and a composite of major adverse cardiac events (MACE) and hospital readmission rates at 30 days and 12 months. There were 41 and 42 patients in Pre-CODE STEMI and CODE STEMI groups respectively. Baseline characteristics were similar. DTBT was significantly reduced by 22.1 min from 67.1 ± 34.9 min Pre-CODE STEMI to 45.0 ± 22.7 min (P = 0.001) in the CODE STEMI group. Door-to-door time (DTDT) was also reduced from 46.3 ± 30.9 min to 29.4 ± 23.3 min (P = 0.006). A greater proportion of CODE STEMI patients achieved the target DTBT ≤90 min (95.2% vs 73.2%, P = 0.007). CODE STEMI patients had less systolic dysfunction measured by a left ventricle ejection fraction of ≤40% (10.0% vs 27.8%, P = 0.07). There were trends to lower in-hospital mortality rates (4.8% vs 9.8%, P = 0.43), MACE at 30 days and 12 months (4.8% vs 9.8%, P = 0.43; 11.9% vs 22.0%, P = 0.25). The novel in-hospital in-hours CODE STEMI notification system significantly reduced DTBT in patients undergoing PPCI.Keywords
This publication has 21 references indexed in Scilit:
- Reperfusion therapy for STEMI: is there still a role for thrombolysis in the era of primary percutaneous coronary intervention?The Lancet, 2013
- 2011 Addendum to the Guidelines for the Management of Acute Coronary Syndromes 2006Heart, Lung and Circulation, 2011
- Improvements in Door-to-Balloon Time in the United States, 2005 to 2010Journal of the American College of Cardiology, 2011
- Impact of 24‐hr in‐hospital interventional cardiology team on timeliness of reperfusion for ST‐segment elevation myocardial infarctionCatheterization and Cardiovascular Interventions, 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 infarctionInternational Journal of Clinical Practice, 2009
- The Effect of Direct Communication between Emergency Physicians and Interventional Cardiologists on Door to Balloon Times in STEMIJournal of Korean Medical Science, 2008
- Effect of Door-to-Balloon Time on Mortality in Patients With ST-Segment Elevation Myocardial InfarctionJournal of Invasive Cardiology, 2006
- Troponin Elevation After Percutaneous Coronary Intervention Directly Represents the Extent of Irreversible Myocardial InjuryJournal of the American College of Cardiology, 2005
- Time Delay to Treatment and Mortality in Primary Angioplasty for Acute Myocardial InfarctionJournal of the American College of Cardiology, 2004
- The wavefront phenomenon of ischemic cell death. 1. Myocardial infarct size vs duration of coronary occlusion in dogs.Journal of the American College of Cardiology, 1977