Open AccessImproved door-to-balloon time for primary percutaneous coronary intervention for patients conveyed via emergency ambulance service
Author(s) -
Zhenghong Liu,
Mian Jie Lim,
Pin Pin Pek,
Aaron Wong,
Kenneth Tan,
Khung Keong Yeo,
Marcus Eng Hock Ong
Publication year - 2021
Publication title -
annals, academy of medicine, singapore/annals of the academy of medicine, singapore
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.299
H-Index - 60
ISSN - 0304-4602
DOI - 10.47102/annals-acadmedsg.2021153
Subject(s) - medicine , door to balloon , interquartile range , percutaneous coronary intervention , emergency medicine , emergency department , myocardial infarction , emergency medical services , retrospective cohort study , ambulance service , medical emergency , primary angioplasty , psychiatry
: Early reperfusion of ST-segment elevation myocardial infarction (STEMI) results inbetter outcomes. Interventions that have resulted in shorter door-to-balloon (DTB) time includeprehospital cardiovascular laboratory activation and prehospital electrocardiogram (ECG) transmission,which are only available for patients who arrive via emergency ambulances. We assessed the impactof mode of transport on DTB time in a single tertiary institution and evaluated the factors that affectedvarious components of DTB time.Methods: We conducted a retrospective cohort study using registry data of patients diagnosed withSTEMI in the emergency department (ED) who underwent primary percutaneous coronaryintervention. We compared patients who arrived by emergency ambulances with those who came viatheir own transport. The primary study end point was DTB, defined as the earliest time a patient arrivedin the ED to balloon inflation. As deidentified data was used, ethics review was waived.Results: A total of 321 patients were included for analysis after excluding 7 with missing data. Themean age was 61.4±11.4 years old with 49 (15.3%) females. Ninety-nine (30.8%) patients arrivedby emergency ambulance. The median DTB time was shorter for patients arriving by ambulanceversus own transport (52min, interquartile range [IQR] 45–61 vs 67min, IQR 59–74; P<0.001), withshorter door-to-ECG and door-to-activation time.Conclusion: Arrival via emergency ambulance was associated with a decreased DTB for STEMIpatients compared to arriving via own transport. There is a need for public education to increase theusage of emergency ambulances for suspected heart attacks to improve outcomes.Keywords: Cardiovascular lab activation, door-to-balloon time, emergency ambulance, primary PCI, STEMI