PMID- 21598809
OWN - NLM
STAT- MEDLINE
DCOM- 20110614
LR  - 20191210
IS  - 1565-1088 (Print)
VI  - 13
IP  - 4
DP  - 2011 Apr
TI  - Bypassing the emergency room to reduce door-to-balloon time and improve outcomes 
      of patients with ST elevation myocardial infarction: the Acute Coronary Syndrome 
      Israeli Survey experience.
PG  - 216-9
AB  - BACKGROUND: Rapid reperfusion of an infarct-related artery is crucial for the 
      successful treatment of ST elevation myocardial infarction. Every effort should 
      be made to shorten door-to-balloon time. OBJECTIVES: To investigate whether 
      bypassing the emergency room (ER) has a positive influence on door-to-balloon 
      time in patients presenting with ST elevation myocardial infarction (STEMI) and 
      whether the reduction in door-to-balloon time improves patients' clinical 
      outcome. METHODS: We analyzed data of 776 patients with STEMI from the 2004 and 
      the 2006 Acute Coronary Syndrome Israeli Survey (ACSIS) registry. The ACSIS is a 
      biennial survey on acute myocardial infarction performed in all 25 intensive 
      cardiac care units in Israel during a 2-month period. Twenty-five percent of 
      patients (193 of 776) arrived directly to the intensive cardiac care unit (ICCU) 
      and 75% (583 of 776) were assessed first in the ER. We compared door-to-balloon 
      time, ejection fraction, 30 days MACE (major adverse cardiac and cerebrovascular 
      events) and 30 days mortality in the two study groups. RESULTS: There was 
      significantly shorter door-to-balloon time in the direct ICCU group as compared 
      with the ER group (45 vs. 79 minutes, P< 0.002). Patients in the direct ICCU 
      group were more likely to have door-to-balloon time of less than 90 minutes in 
      accordance with ACC/AHA guidelines (88.7% vs. 59.2%, P < 0.0001). Moreover, 
      patients in the direct ICCU group were less likely to have left ventricular 
      ejection fraction < 30% (5.4% vs. 12.2%, P= 0.045) and less likely to have 
      symptoms of overt congestive heart failure. Lastly, 30 days MACE was 
      significantly lower in the direct ICCU group (22 vs. 30%, P< 0.004). CONCLUSIONS: 
      There is significant reduction of the door-to-balloon time in the direct ICCU 
      admission strategy. This reduction translates into improvement in clinical 
      outcome of patients. It is reasonable to apply the direct ICCU strategy to 
      patients with STEMI.
FAU - Lubovich, Alla
AU  - Lubovich A
AD  - Department of Cardiology, Bnai Zion Medical Center, Haifa, Israel. 
      alla.lubovich@b-zion.org.il
FAU - Hamood, Hatem
AU  - Hamood H
FAU - Behar, Solomon
AU  - Behar S
FAU - Rosenschein, Uri
AU  - Rosenschein U
LA  - eng
PT  - Journal Article
PL  - Israel
TA  - Isr Med Assoc J
JT  - The Israel Medical Association journal : IMAJ
JID - 100930740
SB  - IM
MH  - Aged
MH  - Angioplasty, Balloon, Coronary
MH  - *Emergency Service, Hospital
MH  - Female
MH  - Hospitalization/trends
MH  - Humans
MH  - *Intensive Care Units
MH  - Israel
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/*therapy
MH  - *Outcome Assessment, Health Care
EDAT- 2011/05/24 06:00
MHDA- 2011/06/15 06:00
CRDT- 2011/05/24 06:00
PHST- 2011/05/24 06:00 [entrez]
PHST- 2011/05/24 06:00 [pubmed]
PHST- 2011/06/15 06:00 [medline]
PST - ppublish
SO  - Isr Med Assoc J. 2011 Apr;13(4):216-9.