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Impact of 24‐hr in‐hospital interventional cardiology team on timeliness of reperfusion for ST‐segment elevation myocardial infarction
Author(s) -
Allaqaband Suhail,
Jan M. Fuad,
Banday Wamiq Y.,
Schlemm Angela,
Ahmed S. Hinan,
Mori Naoyo,
Oldridge Neil,
Gupta Anjan,
Bajwa Tanvir
Publication year - 2010
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.22419
Subject(s) - medicine , mace , myocardial infarction , percutaneous coronary intervention , cardiology , hazard ratio , odds ratio , confidence interval , door to balloon , st segment , conventional pci , reperfusion therapy , interventional cardiology , angioplasty , primary angioplasty
Objective : We studied the effect of 24 hr a day, 7 days a week interventional cardiology staff on door‐to‐balloon (D2B) time and mortality in patients undergoing primary percutaneous coronary intervention (PPCI) for ST‐segment elevation myocardial infarction (STEMI). Background : Any delay in PPCI in acute STEMI is associated with higher mortality and, therefore, time to treatment should be as short as possible. Despite the use of several strategies, goal D2B time of <90 min remains elusive. Methods : The study examined 790 consecutive STEMI patients treated with PPCI as the reperfusion therapy of choice. Patients were grouped into a pre‐24×7 and post‐24×7 cohort to study the impact of the new protocol on D2B time and major adverse cardiovascular events (MACE) and mortality. Results : Median D2B time decreased from 99 min in the pre‐24×7 group to 55 min in the post‐24×7 group ( P = 0.001) and was not influenced by time of day or day of week. Adjusted for patient and clinical characteristics, the pre‐24×7 group had increased in‐hospital cardiovascular mortality (odds ratio 1.94, 95% confidence interval 0.95–3.94; P = 0.048) and MACE (odds ratio 1.66, 95% confidence interval 1.10–2.49; P = 0.009) compared with the post‐24×7 group. Prolonged D2B time was also associated with higher 1‐year overall mortality in the pre‐24×7 group compared with the post‐24×7 group (12.8% vs. 8.1%; hazard ratio 1.17, 95% confidence interval 1.04–2.66; P = 0.044). Conclusions : Round‐the‐clock, in‐hospital interventional cardiology team consistently and significantly reduces D2B time, in‐hospital cardiovascular mortality, MACE, and 1‐year mortality in patients with STEMI. © 2010 Wiley‐Liss, Inc.