Key result
An in-house STEMI team is linked to a 71-minute D2B reduction and lower cardiovascular rehospitalization.
Why the study?
Few programs have been enacted to systematically achieve routine door-to-balloon times below 60 minutes for STEMI patients undergoing primary PCI.
Does a 24-hour in-house interventional team program reduce door-to-balloon times and improve clinical outcomes in patients with STEMI?
Cohort
Does a 24-hour in-house interventional team program reduce door-to-balloon times and improve clinical outcomes in patients with STEMI?
Implementation of a 24-hour in-house STEMI team significantly reduces door-to-balloon times, hospital length of stay, and 6-month cardiovascular rehospitalizations.
May support 24-hour in-house STEMI teams; leaves open confirmation of benefits in randomized trials.
BACKGROUND: Over the last decade, significant advances in ST-elevation myocardial infarction (STEMI) workflow have resulted in most hospitals reporting door-to-balloon (D2B) times within the 90 min standard. Few programs have been enacted to systematically attempt to achieve routine D2B within 60 min. We sought to determine whether 24-hr in-house catheterization laboratory coverage via an In-House Interventional Team Program (IHIT) could achieve D2B times below 60 min for STEMI and to compare the results to the standard primary percutaneous coronary intervention (PCI) approach. METHODS: An IHIT program was established consisting of an attending interventional cardiologist, and a catheterization laboratory team present in-hospital 24 hr/day. For all consecutive STEMI patients, we compared the standard primary PCI approach during the two years prior to the program (group A) to the initial 20 months of the IHIT program (group B), and repeated this analysis for only CMS-reportable patients. The D2B process was analyzed by calculating workflow intervals. The primary endpoint was D2B process times, and secondary endpoints included in-hospital and 6-month cardiovascular outcomes and resource utilization. RESULTS: An IHIT program for STEMI resulted in significant reductions across all treatment intervals with an overall 57% reduction in D2B time, and an absolute reduction in mean D2B time of 71 min. There were no differences pre- and post-program implementation in regard to individual or composite components of in-hospital cardiovascular outcomes; however at 6 months, there was a reduction in cardiovascular rehospitalization after program implementation (30 vs. 5%, P < 0.01). The IHIT program resulted in a significant reduction in length-of-stay (LOS) (90 ± 102 vs. 197 ± 303 hr, P = 0.02), and critical care time (54 ± 97 vs. 149 ± 299 hr, P = 0.02). CONCLUSIONS: Availability of an in-house 24-hr STEMI team significantly decreased reperfusion time and led to improved clinical outcomes and a shorter LOS for PCI-treated STEMI patients.
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Nguyen et al. (2014) conducted a cohort in ST-elevation myocardial infarction (STEMI). 24-hour In-House Interventional Team Program (IHIT) vs. Standard primary PCI approach was evaluated on Door-to-balloon (D2B) process times (71 min absolute reduction). A 24-hour in-house STEMI team reduced mean door-to-balloon time by 71 minutes and lowered 6-month cardiovascular rehospitalization compared to the standard approach (5% vs 30%, P<0.01).
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