Door-to-balloon time in the treatment of ST segment elevation myocardial infarction in a tertiary care center in Saudi Arabia.

BACKGROUND

Atherosclerotic heart disease is still a leading cause of mortality despite improvements in cardiovascular care. Percutaneous coronary intervention (PCI) is the recommended reperfusion therapy in acute ST-elevation myocardial infarction (STEMI), and the international guideline is to achieve a door-to-balloon (D2B) time within 90 minutes of patient arrival to an emergency department (ED).

OBJECTIVES

Describe interventions, data for the study period, challenges in ensuring 24/7 patient access to PCI and quality indicators.

DESIGN

Retrospective observational study.

SETTING

Tertiary care institution in Riyadh, Saudi Arabia.

PATIENTS AND METHODS

We included all acute coronary syndrome patients from 2010-2018 who presented or were transferred to our ED from nearby non-PCI capable hospitals, and for whom a 'code heart' was activated. Electronic medical records and the patient care report from the ambulance services were accessed for data collection.

MAIN OUTCOME MEASURES

D2B time, readmission and mortality rate.

SAMPLE SIZE AND CHARACTERISTICS

354 patients, mean age (standard deviation) 55.6 (12.6) years, males 84.5% (n=299).

RESULTS

STEMI patients constituted 94% (n=334) of the study group; the others had non-STEMI or unstable angina. Hypertension (51%) was the most prevalent risk factor. Coronary artery stenting was the most frequent intervention (77.4%) followed by medical therapy (14.7%). The most common culprit artery was the left anterior descending (52.5%) followed by the right coronary artery (26.0%). A D2B time of within 90 minutes was achieved in over 85% of the patients in four of the years in the 278 patients who underwent PCI. The median D2B time (interquar-tile range) over 2010-2018 was 79 (31) minutes.

CONCLUSION

Meeting the international benchmark of D2B time within 90 minutes for STEMI patients is achievable when the main stakeholders collaborate in patient-centric care. Our patient demographics represent regional trends.

LIMITATIONS

Patient acceptance to our institution is based upon eligibility criteria. Transfer of 'code heart' patients from other institutions was carried out by our ambulance team. The credentials and experience of cardiologists, emergency physicians, and ambulance services are not standardized across the country. Therefore, the results may not be generalizable to other institutions.

CONFLICT OF INTEREST

None.