Nguyen Bryant, Fennessy Michelle, Leya Ferdinand, Nowak Wojciech, Ryan Michael, Freeberg Sheldon, Gill Jasrai, Dieter Robert S, Steen Lowell, Lewis Bruce, Cichon Mark, Probst Beatrice, Jarotkiewicz Michael, Wilber David, Lopez John J
Division of Cardiology, Department of Medicine, Loyola University Medical Center, Stritch School of Medicine, Maywood, Illinois.
Catheter Cardiovasc Interv. 2015 Aug;86(2):186-96. doi: 10.1002/ccd.25769. Epub 2015 Feb 25.
Over the last decade, significant advances in ST-elevation myocardial infarction (STEMI) workflow have resulted in most hospitals reporting door-to-balloon (D2B) times within the 90 min standard. Few programs have been enacted to systematically attempt to achieve routine D2B within 60 min. We sought to determine whether 24-hr in-house catheterization laboratory coverage via an In-House Interventional Team Program (IHIT) could achieve D2B times below 60 min for STEMI and to compare the results to the standard primary percutaneous coronary intervention (PCI) approach.
An IHIT program was established consisting of an attending interventional cardiologist, and a catheterization laboratory team present in-hospital 24 hr/day. For all consecutive STEMI patients, we compared the standard primary PCI approach during the two years prior to the program (group A) to the initial 20 months of the IHIT program (group B), and repeated this analysis for only CMS-reportable patients. The D2B process was analyzed by calculating workflow intervals. The primary endpoint was D2B process times, and secondary endpoints included in-hospital and 6-month cardiovascular outcomes and resource utilization.
An IHIT program for STEMI resulted in significant reductions across all treatment intervals with an overall 57% reduction in D2B time, and an absolute reduction in mean D2B time of 71 min. There were no differences pre- and post-program implementation in regard to individual or composite components of in-hospital cardiovascular outcomes; however at 6 months, there was a reduction in cardiovascular rehospitalization after program implementation (30 vs. 5%, P < 0.01). The IHIT program resulted in a significant reduction in length-of-stay (LOS) (90 ± 102 vs. 197 ± 303 hr, P = 0.02), and critical care time (54 ± 97 vs. 149 ± 299 hr, P = 0.02).
Availability of an in-house 24-hr STEMI team significantly decreased reperfusion time and led to improved clinical outcomes and a shorter LOS for PCI-treated STEMI patients.
在过去十年中，ST段抬高型心肌梗死（STEMI）治疗流程取得了重大进展，多数医院报告的门球时间（D2B）均在90分钟标准内。很少有项目系统地尝试将常规D2B时间控制在60分钟以内。我们旨在确定通过院内介入团队项目（IHIT）实现24小时院内导管室覆盖能否使STEMI患者的D2B时间低于60分钟，并将结果与标准的直接经皮冠状动脉介入治疗（PCI）方法进行比较。
建立了一个IHIT项目，由一名主治介入心脏病专家和一个每天24小时驻院的导管室团队组成。对于所有连续的STEMI患者，我们将项目开展前两年的标准直接PCI方法（A组）与IHIT项目最初20个月的情况（B组）进行比较，并仅对可向医疗保险和医疗补助服务中心（CMS）报告的患者重复此分析。通过计算工作流程间隔来分析D2B过程。主要终点是D2B过程时间，次要终点包括院内和6个月时的心血管结局及资源利用情况。
针对STEMI的IHIT项目使所有治疗间隔均显著缩短，D2B时间总体减少了57%，平均D2B时间绝对减少了71分钟。项目实施前后，院内心血管结局的个体或综合指标并无差异；然而在6个月时，项目实施后心血管再住院率有所降低（30%对5%，P＜0.01）。IHIT项目使住院时间（LOS）显著缩短（90±102小时对197±303小时，P = 0.02），重症监护时间也显著缩短（54±97小时对149±299小时，P = 0.02）。
拥有一个24小时驻院的STEMI团队可显著缩短再灌注时间，并改善PCI治疗的STEMI患者的临床结局，缩短住院时间。
