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Impact of minimising door-to-balloon times in ST-elevation myocardial infarction to less than 30 min on outcome: an analysis over an 8-year period in a tertiary care centre

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Abstract

Background

Guidelines recommend door-to-balloon times (DBTs) below 60 min for patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).

The purpose of this study was to determine if an optimised STEMI-protocol reduces DBT and increases the number of patients to receive PCI within 60 min of hospital presentation. We hypothesised that DBT of <30 min can be accomplished for the majority of patients.

Methods and results

Between 2001 and 2008 data from 1,146 consecutive patients with acute STEMI admitted for primary PCI within 12 h after symptom-onset were analysed. Times to angioplasty from symptom-onset (pain-to-balloon time, PBT) and from hospital arrival (DBT) to PCI and clinical outcomes were analysed. In the end of 2003 numerous strategies were implemented to reduce revascularisation times. These strategies resulted in a stable reduction of median DBT to 29 min [interquartile range (IQR) 22–39]. Overall, 94% of patients had median DBT < 60 min and 56% <30 min. Consequently, PBT was significantly reduced from median 218 min (IQR 168–286) to 167 min (IQR 119–245) for non-transferred patients. Major cardiac adverse events (composite of congestive heart failure, reinfarction and cardiac death) were significantly associated with DBT > 30 min and age, systolic blood pressure, anterior infarction, PBT > 4 h, cardiogenic shock as well as multivessel disease.

Conclusions

A dedicated STEMI-protocol including several hospital strategies is feasible during daily clinical practice to decrease revascularisation times, results in a greater proportion of patients achieving guideline recommendations, and is associated with an improved clinical outcome.

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Acknowledgments

The past and current success of the STEMI program at our PCI centre is entirely due to the dedicated efforts of all emergency physicians, paramedics, and medical staff and nurses from the cardiology intensive care unit of the University of Leipzig-Heart Centre. Additionally, we thank Holger Bogatsch, MD from Clinical Trial Centre, University of Leipzig, Leipzig, Germany for supporting statistical analysis.

Conflict of interest

None declared.

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Authors and Affiliations

  1. Department of Internal Medicine/Cardiology, University of Leipzig, Heart Centre, Strümpellstr. 39, 04289, Leipzig, Germany

    Ulrike M. Müller, Ingo Eitel, Kristina Eckrich, Sandra Erbs, Axel Linke, Sven Möbius-Winkler, Gerhard C. Schuler & Holger Thiele

  2. Clinical Trial Centre, University of Leipzig, Leipzig, Germany

    Meinhard Mende

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  1. Ulrike M. Müller
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  2. Ingo Eitel
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  3. Kristina Eckrich
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  4. Sandra Erbs
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  9. Holger Thiele
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Corresponding author

Correspondence to Ulrike M. Müller.

Additional information

U. M. Müller and I. Eitel contributed equally to this study.

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Müller, U.M., Eitel, I., Eckrich, K. et al. Impact of minimising door-to-balloon times in ST-elevation myocardial infarction to less than 30 min on outcome: an analysis over an 8-year period in a tertiary care centre. Clin Res Cardiol 100, 297–309 (2011). https://doi.org/10.1007/s00392-010-0242-7

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