Prehospital emergency physician activation of interventional cardiology team reduces door-to-balloon time in ST-elevation myocardial infarction.

QUESTION UNDER STUDY

To explore whether early activation of an interventional cardiology team, by prehospital emergency physicians, reduces door-to-balloon time (DTBT) in patients with ST-elevation myocardial infarction (STEMI) diagnosed with prehospital ECG.

DESIGN

before-after comparison.

SETTING

emergency department (ED) of an urban teaching hospital with a catheterisation laboratory open continuously.

STUDY SUBJECTS

patients with STEMI diagnosed in the prehospital setting or in the ED within 12 hours of symptoms.

INTERVENTION

a paging system or "STEMI alarm", activated by prehospital physicians, which simultaneously notified both the catherisation laboratory and cardiology teams before the patient's arrival to the ED.

OUTCOME MEASURES

DTBT and the proportion of patients with DTBT <90 minutes.

RESULTS

A total of 196 patients were included; 77 before and 119 after implementation of the "STEMI alarm". Between the two periods, median DTBT decreased from 109 to 76 minutes (p <0.001) and the proportion of patients treated within 90 minutes increased from 36% to 66% (p <0.001). During intervention, the STEMI alarm was activated in 67 patients (56%). In these cases the median DTBT was 50 minutes, with 96% within 90 minutes. The alarm was inappropriately activated in 9 cases (11%).

CONCLUSIONS

Catheterisation laboratory activation by a prehospital emergency physician markedly reduces DTBT in STEMI patients.