Key result
ED-diagnosed STEMI achieves shortest diagnosis-to-balloon time at ~78 minutes compared to EMS and transfer pathways.
Why the study?
Varied locations of STEMI diagnosis challenge the use of door-to-balloon-time as the primary evaluative measure of STEMI treatment pathways.
Does the location of STEMI diagnostic ECG affect timely emergency STEMI treatment mobilization and diagnosis-to-balloon time?
Cohort (n=207)
No
Does the location of STEMI diagnostic ECG affect timely emergency STEMI treatment mobilization and diagnosis-to-balloon time?
Evaluating diagnosis-to-balloon time in addition to traditional door-to-balloon time uncovers distinct bottlenecks in STEMI care based on where the initial diagnostic ECG is acquired.
ED STEMI diagnosis linked to shortest diagnosis-to-balloon times; leaves open whether pathway-specific interventions can reduce EMS and referral delays.
OBJECTIVE: From the perspective of percutaneous coronary intervention (PCI) centers, locations of ST-segment elevation myocardial infarction (STEMI) diagnosis can include a referring facility, emergency medical services (EMS) transporting to a PCI center, or the PCI center's emergency department (ED). This challenges the use of door-to-balloon-time as the primary evaluative measure of STEMI treatment pathways. Our objective was to identify opportunities to improve care by quantifying differences in the timeliness of STEMI treatment mobilization based on the location of the diagnostic ECG. METHODS: This 3-year, single-center, retrospective cohort study classified patients by diagnostic ECG location: referring facility, EMS, or PCI center ED. We quantified door-to-balloon-time and diagnosis-to-balloon-time with its care subintervals. RESULTS: Of 207 ED STEMI patients, 180 (87%) received PCI. Median diagnosis-to-balloon-times were shortest among the ED-diagnosed (78 minutes [interquartile range (IQR), 61-92]), followed by EMS-identified patients (89 minutes [IQR, 78-122]), and longest among those referred (140 minutes [IQR, 119-160]), reflecting time for transport to the PCI center. Conversely, referred patients had the shortest median door-to-balloon-times (38 minutes [IQR, 34-43]), followed by the EMS-identified (64 minutes [IQR, 47-77]), whereas ED-diagnosed patients had the longest (89 minutes [IQR, 70-114]), reflecting diagnosis and catheterization lab activation frequently occurring before PCI center ED arrival for referred and EMS-identified patients. CONCLUSIONS: Diagnosis-to-balloon-time and its care subintervals are complementary to the traditional door-to-balloon-times as measures of the STEMI treatment process. Together, they highlight opportunities to improve timely identification among ED-diagnosed patients, use of out-of-hospital cath lab activation for EMS-identified patients, and encourage pathways for referred patients to bypass PCI center EDs.
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Yiadom et al. (2021) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=207). Location of diagnostic ECG (referring facility, EMS, or PCI center ED) was evaluated on Diagnosis-to-PCI balloon inflation time. Median diagnosis-to-balloon times were shortest for ED-diagnosed patients (78 minutes) compared to EMS-identified (89 minutes) and referred patients (140 minutes).
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