Key result
The PREPARE protocol significantly increased the proportion of transferred STEMI patients achieving an adequate door-to-balloon time within 120 minutes compared to conventional transfer (60.0% vs 30.4%, OR 3.399).
Why the study?
Prompt reperfusion is important in STEMI, but interhospital transfer for PCI often causes delays because not all hospitals offer PCI.
Does the PREPARE protocol improve adequate D1-to-B time in STEMI patients transferred for PCI?
Observational (n=96)
No
Does the PREPARE protocol improve adequate D1-to-B time in STEMI patients transferred for PCI?
Odds Ratio: 3.399 (95% CI 1.15–10.05)
Absolute Event Rate: 60% vs 30.4%
p-value: p=0.027
A regionalization protocol involving early PCI team activation and real-time ECG sharing significantly improved the rate of adequate door-to-balloon times in transferred STEMI patients.
May support PREPARE protocol adoption for STEMI transfers to improve D2B times; leaves open randomized confirmation before practice change.
OBJECTIVE: Prompt reperfusion is important for patients with ST elevation myocardial infarction (STEMI). However, patients often require interhospital transfer for percutaneous coronary intervention (PCI) because not all hospitals can provide. The purpose of this study is to reduce the PCI delay using a regionalization protocol in patients with STEMI following transfer from another hospital lacking PCI facility. METHODS: We established a revascularization protocol designated as Preparing Revascularization Effort before Patients' Arrival via Regionalization Engagement (PREPARE) for the STEMI patients transferred from an outside regional hospital. The protocol included immediate referral acceptance by an emergency physician, real-time electrocardiogram sharing via mobile phone and early activation of the PCI team. We analyzed the differences between the PREPARE and the non-PREPARE groups. RESULTS: In the PREPARE group, the median time from the first hospital visit to the ballooning procedure via PCI at the receiving facility (D1-to-B time) was 111.0 (interquartile range 97.0-130.0) minutes, which was significantly shorter than in the non-PREPARE group 134.0 (interquartile range 115.0-182.0) minutes. The proportion of D1-to-B time within 120 minutes was 30.4% in the group and 60.0% in the PREPARE group, which represents a significant difference (P=0.004). Multivariate logistic regression analysis revealed that patient transfer via PREPARE protocol (odds ratio, 3.399; 95% confidence interval, 1.150-10.050, P=0.027) was related to adequate D1-to-B time. No statistically significant differences were found in the hospital length of stay or major adverse cardiac events within 4 weeks. CONCLUSION: The PREPARE protocol is an effective strategy to reduce the time to revascularization of the transferred STEMI patients.
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Jung et al. (2020) conducted an observational in ST elevation myocardial infarction (STEMI) requiring interhospital transfer (n=96). PREPARE protocol (Preparing Revascularization Effort before Patients' Arrival via Regionalization Engagement) vs. Conventional transfer method (non-PREPARE) was evaluated on Adequate first door-to-balloon (D1-to-B) time within 120 minutes (OR 3.399, 95% CI 1.150-10.050, p=0.027). The PREPARE protocol significantly increased the proportion of transferred STEMI patients achieving an adequate door-to-balloon time within 120 minutes compared to conventional transfer (60.0% vs 30.4%, OR 3.399).
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