PMID- 21536399
OWN - NLM
STAT- MEDLINE
DCOM- 20120607
LR  - 20120319
IS  - 0736-4679 (Print)
IS  - 0736-4679 (Linking)
VI  - 42
IP  - 3
DP  - 2012 Mar
TI  - "Code STEMI" protocol helps in achieving reduced door-to-balloon times in 
      patients presenting with acute ST-segment elevation myocardial infarction during 
      off-hours.
PG  - 260-6
LID - 10.1016/j.jemermed.2011.03.014 [doi]
AB  - BACKGROUND: Door-to-balloon (D2B) time is conceived as a crucial parameter for 
      evaluating the quality of acute ST-segment elevation myocardial infarction 
      (STEMI) care. Ideally, primary percutaneous intervention should be performed 
      within 90 min of hospital arrival. OBJECTIVES: We sought to determine the impact 
      of emergency physician-activated "Code STEMI" protocol on door-to-balloon times 
      during off-hours. METHODS: Patients were divided into two study groups: one group 
      consisted of 27 STEMI patients who presented during off-hours in the pre-Code 
      STEMI period (January to December 2006) and the second group consisted of 60 
      STEMI patients admitted during off-hours when Code STEMI was fully operational 
      (January 2007 to December 2008). The primary objective was to compare median D2B 
      times in both the study groups. Secondary parameters of interest included the 
      individual components of D2B time, peak serum troponin levels, peak creatine 
      kinase total levels, all-cause in-hospital mortality, 6-month all-cause 
      mortality, and 12-month all-cause mortality. RESULTS: With the implementation of 
      "Code STEMI" protocol, the median D2B time during off-hours dropped to 77 min 
      (interquartile range [IQR] 67-95), representing a 52-min improvement (p = 
      0.0001). ECG-to-catheterization laboratory time demonstrated absolute reduction 
      of 16 min. Median peak troponin-I levels dropped from 62 ng/mL (IQR 23-142) to 25 
      ng/mL (IQR 7-43; p < 0.002). No statistically significant differences were 
      perceived in all-cause mortality among the study groups. CONCLUSIONS: 
      Implementation of "Code STEMI" protocol at our institution significantly reduced 
      D2B times for STEMI during off-hours.
CI  - Copyright A(c) 2012 Elsevier Inc. All rights reserved.
FAU - Bajaj, Sharad
AU  - Bajaj S
AD  - Department of Internal Medicine, St. Joseph's Regional Medical Center, Paterson, 
      New Jersey 07503, USA.
FAU - Parikh, Rupen
AU  - Parikh R
FAU - Gupta, Nishant
AU  - Gupta N
FAU - Aldehneh, Anthony
AU  - Aldehneh A
FAU - Rosenberg, Mark
AU  - Rosenberg M
FAU - Hamdan, Aiman
AU  - Hamdan A
FAU - Bikkina, Mahesh
AU  - Bikkina M
LA  - eng
PT  - Journal Article
DEP - 20110504
PL  - United States
TA  - J Emerg Med
JT  - The Journal of emergency medicine
JID - 8412174
RN  - 0 (Troponin I)
SB  - IM
MH  - After-Hours Care
MH  - Aged
MH  - Angioplasty, Balloon, Coronary/*methods/standards
MH  - Clinical Protocols
MH  - Electrocardiography
MH  - Emergencies
MH  - Emergency Service, Hospital
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/blood/mortality/*therapy
MH  - Time Factors
MH  - Troponin I/blood
MH  - Waiting Lists
EDAT- 2011/05/04 06:00
MHDA- 2012/06/08 06:00
CRDT- 2011/05/04 06:00
PHST- 2010/06/01 00:00 [received]
PHST- 2010/08/14 00:00 [revised]
PHST- 2011/03/17 00:00 [accepted]
PHST- 2011/05/04 06:00 [entrez]
PHST- 2011/05/04 06:00 [pubmed]
PHST- 2012/06/08 06:00 [medline]
AID - S0736-4679(11)00289-7 [pii]
AID - 10.1016/j.jemermed.2011.03.014 [doi]
PST - ppublish
SO  - J Emerg Med. 2012 Mar;42(3):260-6. doi: 10.1016/j.jemermed.2011.03.014. Epub 2011 
      May 4.