Abstract
Objective
To assess the impact of an aggressive protocol to decrease the time from hospital
arrival to onset of reperfusion therapy (“door to balloon [DTB] time”) on the incidence
of false-positive (FP) diagnosis of ST-segment elevation myocardial infarction (STEMI)
and in-hospital mortality.
Patients and Methods
The study population included 1031 consecutive patients with presumed STEMI and confirmed
ST-segment elevation who underwent emergent catheterization between July 1, 2008,
and December 1, 2012, On July 1, 2009, we instituted an aggressive protocol to reduce
DTB time. A quality improvement (QI) initiative was introduced on January 1, 2011,
to maintain short DTB while improving outcomes. Outcomes were compared before and
after the initiation of the DTB time protocol and similarly before and after the QI
initiative. Outcomes were DTB time, the incidence of FP-STEMI, and in-hospital mortality.
A review of the emergency catheterization database for the 10-year period from January
1, 2001, through December 31, 2010, was performed for historical comparison.
Results
Of the 1031 consecutive patients with presumed STEMI who were assessed, 170 were considered
to have FP-STEMI. The median DTB time decreased significantly from 76 to 61 minutes
with the aggressive DTB time protocol (P=.001), accompanied by an increase of FP-STEMI (7.7% vs 16.5%; P=.02). Although a nonsignificant reduction of in-hospital mortality occurred in patients
with true-positive STEMI (P=.60), a significant increase in in-hospital mortality was seen in patients with FP-STEMI
(P=.03). After the QI initiative, a shorter DTB time (59 minutes) was maintained while
decreasing FP-STEMI in-hospital mortality.
Conclusion
Aggressive measures to reduce DTB time were associated with an increased incidence
of FP-STEMI and FP-STEMI in-hospital mortality. Efforts to reduce DTB time should
be monitored systematically to avoid unnecessary procedures that may delay other appropriate
therapies in critically ill patients.
Abbreviations and Acronyms:
DTB (“door to balloon”), ECG (electrocardiography), FP (false-positive), QI (quality improvement), STEMI (ST-segment elevation myocardial infarction), TP (true-positive)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: November 05, 2015
Footnotes
Grant Support: This work was supported in part by an Institutional Development Award from the National Institute of General Medical Sciences of the National Institutes of Health under grant U54-GM104941.
Identification
Copyright
© 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
