Louisiana State University Health Sciences Center Department of Emergency Medicine, Shreveport, LA.
West J Emerg Med. 2010 Sep;11(4):363-6.
Despite American College of Cardiology (ACC) and American Heart Association (AHA) guidelines, many hospitals have door-to-balloon times in excess of 90 minutes. Emergency Department (ED) activation of interventional cardiology has been described as an important strategy to reduce door-to-balloon time. However, prior studies on ED activation have been in suburban hospitals with door-to-balloon times near the ACC/AHA targeted times.
To determine if ED activation of interventional cardiology could significantly improve reperfusion times and reach the ACC/AHA target of 90 minutes or less in a safety net hospital, a Level I trauma center and teaching hospital serving primarily uninsured and underinsured patient population with door-to-balloon times ranking in the lowest quartile of United States hospitals.
In this study, door-to balloon times before and after implementation of ED activation were compared by retrospective chart review.
Eighty patients were included in the study, 48 before and 32 after ED activation of interventional cardiology. Median door-to-balloon time decreased from 163.5 minutes before to 130 minutes after ED activation, a significant difference of 33.5 minutes (p=0.028). Door-to-balloon time on nights, weekends and holidays decreased from a median of 165.5 minutes to 130 minutes, a reduction of 35.5 minutes, which also reached statistical significance (p=0.029).
ED activation of interventional cardiology produced a statistically significant reduction in door-to-balloon time. However, the reduction was not enough to achieve a door-to-balloon time of less than 90 minutes. Safety net hospitals with door-to-balloon times in the lowest quartile nationally may require multiple strategies to achieve targeted myocardial reperfusion times.
尽管美国心脏病学会（ACC）和美国心脏协会（AHA）的指南中有所规定，但许多医院的门球时间仍超过 90 分钟。急诊科（ED）启动介入心脏病学已被描述为缩短门球时间的重要策略。然而，先前关于 ED 启动的研究是在门球时间接近 ACC/AHA 目标时间的郊区医院进行的。
确定 ED 启动介入心脏病学是否可以显著改善再灌注时间，并在一家安全网医院、一级创伤中心和教学医院达到 ACC/AHA 的目标，即 90 分钟或更短时间内，该医院的门球时间在全美医院中排名最低四分之一。
在这项研究中，通过回顾性图表审查比较了 ED 启动前后的门球时间。
这项研究共纳入 80 例患者，其中 48 例在 ED 启动介入心脏病学之前，32 例在 ED 启动之后。中位数门球时间从 ED 启动前的 163.5 分钟缩短至 ED 启动后的 130 分钟，差异有统计学意义（p=0.028）。夜间、周末和节假日的门球时间中位数从 165.5 分钟缩短至 130 分钟，减少了 35.5 分钟，差异也具有统计学意义（p=0.029）。
ED 启动介入心脏病学使门球时间显著缩短。然而，减少的幅度不足以达到小于 90 分钟的门球时间。门球时间在全国最低四分位的安全网医院可能需要多种策略来实现目标心肌再灌注时间。
