Key result
ED cath labs linked to ~61% lower 10-year mortality vs standard labs, driven by faster D2B.
Why the study?
Shorter door-to-balloon time is associated with lower mortality in STEMI, motivating the evaluation of an emergency department catheterization laboratory to reduce door-to-balloon time and mortality compared with standard catheterization laboratories.
Does performing primary percutaneous coronary intervention in an emergency department catheterization laboratory reduce door-to-balloon time and mortality in patients with STEMI compared to a standard catheterization laboratory?
Observational (n=1,053)
No
Does performing primary percutaneous coronary intervention in an emergency department catheterization laboratory reduce door-to-balloon time and mortality in patients with STEMI compared to a standard catheterization laboratory?
Absolute Event Rate: 54% vs 83%
p-value: p=<0.001
Implementing a catheterization laboratory directly within the emergency department is a feasible strategy that significantly reduces door-to-balloon times and is associated with improved short- and long-term mortality in STEMI patients.
ED cath labs were associated with shorter D2B times and lower STEMI mortality; leaves open whether randomized implementation improves outcomes.
BACKGROUND: Percutaneous coronary intervention is the preferred treatment for acute ST-segment elevation myocardial infarction (STEMI), and shorter door-to-balloon time (D2B) is associated with lower mortality. We implemented a catheterization laboratory within the emergency department (ED) as a novel strategy to reduce D2B. OBJECTIVES: The purpose of this paper was to compare D2B and mortality in STEMI patients presenting to ED vs standard catheterization labs at a community hospital. METHODS: We prospectively reviewed consecutive patients presenting with STEMI to our institution between 1998 and 2011 and treated with primary percutaneous coronary intervention. The primary endpoints were D2B and time to death. A multivariable linear regression model was used to assess the relationship between catheterization lab location and D2B. The relationship between D2B and mortality was examined using a Cox proportional hazards model. RESULTS: We included 1,053 STEMI patients (553 in ED vs 500 in standard catheterization labs). Both groups had similar age, sex, race, diabetes, left main disease, and Killip class on presentation. Standard catheterization lab patients were more likely to have left ventricular ejection fraction <40% (11% vs 6.5%). D2B was shorter in ED vs standard cath lab patients (54 vs 83 minutes, P < 0.001). ED catheterization lab patients were more likely to have <30-minute D2B (17% vs <1%, P < 0.001). After covariate adjustment, ED catheterization lab patients had lower 30-day (adjusted hazard ratio [adj HR]: 0.54, 95% confidence interval [CI] 0.29-0.99), 1-year (adj HR: 0.58, 95% CI: 0.37-0.91), and 10-year mortality (adj HR: 0.39, 95% CI: 0.29-0.53) than standard catheterization lab patients. CONCLUSIONS: Implementation of an ED catheterization lab is a feasible strategy which may reduce D2B and STEMI mortality.
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Sabe et al. (2025) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=1,053). Emergency department (ED) catheterization laboratory vs. Standard catheterization laboratory was evaluated on Median door-to-balloon (D2B) time (minutes) (p=<0.001). An emergency department catheterization laboratory reduced median door-to-balloon time to 54 minutes versus 83 minutes in standard labs and lowered 10-year mortality (HR 0.39).
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