i2 SUMMIT

A198.E1858

JACC March 9, 2010

Volume 55, issue 10A

TWENTY-FOUR-HOUR IN-HOSPITAL INTERVENTIONAL CARDIOLOGY TEAM AND IMPACT ON DOOR-

TO-BALLOON TIMES: SURPASSING THE AMERICAN COLLEGE OF CARDIOLOGY DOOR-TO-BALLOON

ALLIANCE BENCHMARK

i2 Poster ContributionsGeorgia World Congress Center, Hall B5

Sunday, March 14, 2010, 3:30 p.m.-4:30 p.m.

Session Title: DES II, Restenosis, Left Main and OutcomesAbstract Category: Outcomes/Operator Volume/Public Reporting/Misc. Topics/Guidelines

Presentation Number: 2502-520

Authors: M. Fuad Jan, Anthony C. DeFranco, Naoyo Mori, Angela Schlemm, Anjan Gupta, Suhail Allaqaband, Tanvir Bajwa, Aurora Cardiovasc Svcs,

Aurora Sinai/St. Luke’s Med Ctrs, Univ Wisconsin Sch Med & Public Health-MCC, Milwaukee, WI, Center for Urban Population Health, University of

Wisconsin-Milwaukee, Milwaukee, WI

Background: The ACC Door-to-Balloon (D2B) Alliance target is a >75% rate of D2B time ≤90 min. Several strategies report a link between specific

hospital-based initiatives for STEMI and shorter D2B time, but current data from National Cardiovascular Data Registry demonstrates continuing

inertia with only 58% of STEMI patients reperfused in ≤90 min. We evaluated timely reperfusion for STEMI with primary percutaneous coronary

intervention (PPCI) using a novel in-hospital 24x7 STEMI protocol.

Methods: The protocol involved a 24 hours a day, 7 days a week call for the interventional cardiologist and the catheterization laboratory (CCL)

staff and included the following strategies: 1) rapid ECG acquisition and ED physician interpretation in ≤10 min of hospital arrival; 2) ED physician

activation of the 24x7 team with a single call; 3) calibration of the clocks in the ED and the CCL checked monthly; and 4) feedback provided to staff

within 24-72 hours.

Results: Between April 1, 2004 and June 30, 2009 a total of 611 consecutive non-transfer patients (median age 60, women 30.3%) underwent

PPCI for acute STEMI. Median D2B was 55 min with an 89% (n=545) rate of D2B <90 min. Secondary analyses of this cohort demonstrated a 58.7%

rate of D2B <60 min and a 6.7% rate of D2B <30 min. Longer D2B times were associated with increased age, female sex and clinical instability in

the ED.

Table 1. Distribution of Door-to-Balloon Time (Median=55 min, Interquartile Range=43-71 min)

Time (minutes) No. of patients (%)

<30 41 (6.7%)

30-59 318 (52.1%)

60-89 186 (30.4%)

90-119 39 (6.4%)

120-149 13 (2.1%)

150-179 5 (0.8%)

180-209 6 (1.0%)

≥210 3 (0.5%)

Total 611 (100.0%)

Conclusion: An in-hospital 24x7 STEMI protocol achieved an 89% rate of D2B <90 min, surpassing the American College of Cardiology D2B

Alliance benchmark.