Door-to-Balloon Times for Patients With ST-Segment Elevation Myocardial Infarction Requiring Interhospital Transfer for Primary Percutaneous Coronary Intervention: A Report From the National Cardiovascular Data Registry

Study Questions:

What are the trends in door-to-balloon time in patients with ST-segment elevation myocardial infarction (STEMI) who require transfer to another hospital for primary percutaneous coronary intervention (PCI)?

Methods:

The authors assessed the change in door-to-balloon time between 2005 and 2007 at 790 hospitals participating in the American College of Cardiology National Cardiovascular Data Catheterization PCI Registry. The cohort was comprised of 29,248 transfer and 86,382 direct-arrival STEMI patients.

Results:

A decline in the door-to-balloon time was noted for both direct admit (median 91-71 minutes) and transfer patients (median 167-138 minutes). The number of patients receiving PCI within 90 minutes was significantly greater in the direct admits compared with the transfer patients (64% vs. 10%). The improvement in door-to-balloon time was slower in the transfer patients (5% vs. 9% relative decrease per year, p < 0.001).

Conclusions:

The authors concluded that while there has been a significant decrease in door-to-balloon time in patients presenting directly to PCI-capable hospitals, patients presenting to non–PCI-capable hospitals continue to face considerable delay to reperfusion.

Perspective:

This important study highlights the ongoing need for reducing time to reperfusion in patients who present to hospitals that do not have PCI capability. While often deemed difficult due to the involvement of multiple agencies, there are clear examples of communities that have successfully developed systems for remarkably efficient transfer and PCI (Blankenship JC, et al., J Am Coll Cardiol 2011;57:272-9). There is an urgent need to replicate these efforts across the country.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: Registries, Myocardial Infarction, Catheterization, United States, Percutaneous Coronary Intervention


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