PMID- 17985378
OWN - NLM
STAT- MEDLINE
DCOM- 20080410
LR  - 20101118
IS  - 1522-726X (Electronic)
IS  - 1522-1946 (Linking)
VI  - 71
IP  - 2
DP  - 2008 Feb 1
TI  - An analysis of door-to-balloon time in a single center to determine causes of 
      delay and possibilities for improvement.
PG  - 152-7
AB  - OBJECTIVES: We analyzed door-to-balloon times in our institution to identify 
      those factors which significantly prolong time to treatment in ST elevation 
      myocardial infarction (STEMI). BACKGROUND: Recent data have shown that patients 
      with myocardial infarction transferred from one institution to another for PCI 
      and those presenting outside of normal working hours suffer considerably 
      prolonged door-to-balloon times. METHODS: We analyzed the door-to-balloon time 
      and its components from January 2005 to March 2006 in 167 consecutive patients 
      presenting with STEMI to determine which variables were associated with delays. 
      RESULTS: The median door to balloon (DTB) time of all patients was 127 min. DTB 
      was 62 min (P = 0.001) for patients presenting directly during working hours, 
      111.5 min for patients presenting directly during on-call hours, 157.5 min for 
      patients presenting to outside hospitals during working hours and 149 min for 
      patients transferred from outside hospitals during on-call hours. Factors that 
      significantly lengthened DTB time included presentation during on-call hours (P = 
      0.007), outside hospital presentation (<0.001), prolonged time from chest pain 
      onset to presentation (P = 0.004), absence of chest pain on presentation (P = 
      0.01), and cardiac arrest before PCI (P = 0.05). CONCLUSION: In our center, 
      transport time and on-call hour delays account for the majority of reperfusion 
      delay. Other factors that influenced delay were atypical presentation without 
      chest pain, borderline ST changes, or delayed presentation. Thus, transfer from 
      an outside facility, presentation after working hours, and having a difficult 
      diagnosis all influence the rapidity of treatment. The implementation of an 
      in-house STEMI response team may reduce the process induced delays and improve 
      door-to-balloon times.
CI  - Copyright 2008 Wiley-Liss, Inc.
FAU - Wu, Eugene B
AU  - Wu EB
AD  - Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, 
      USA. ebwu@netvigator.com
FAU - Arora, Nipun
AU  - Arora N
FAU - Eisenhauer, Andrew C
AU  - Eisenhauer AC
FAU - Resnic, Frederic S
AU  - Resnic FS
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Catheter Cardiovasc Interv
JT  - Catheterization and cardiovascular interventions : official journal of the 
      Society for Cardiac Angiography & Interventions
JID - 100884139
SB  - IM
CIN - Catheter Cardiovasc Interv. 2008 Feb 1;71(2):158-9. PMID: 18231994
MH  - Aged
MH  - Aged, 80 and over
MH  - *Angioplasty, Balloon, Coronary/standards
MH  - Benchmarking
MH  - Cardiology Service, Hospital/*standards
MH  - Female
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/diagnosis/*therapy
MH  - *Patient Transfer
MH  - Referral and Consultation
MH  - Time
EDAT- 2007/11/07 09:00
MHDA- 2008/04/11 09:00
CRDT- 2007/11/07 09:00
PHST- 2007/11/07 09:00 [pubmed]
PHST- 2008/04/11 09:00 [medline]
PHST- 2007/11/07 09:00 [entrez]
AID - 10.1002/ccd.21315 [doi]
PST - ppublish
SO  - Catheter Cardiovasc Interv. 2008 Feb 1;71(2):152-7. doi: 10.1002/ccd.21315.