Quality improvement in the door-to-balloon times for ST-elevation myocardial infarction patients presenting without chest pain

Authors

William B. Borden, Weill Cornell Medicine
Michelle M. Fennessy, Loyola University Stritch School of Medicine
Anne M. O'Connor, Pritzker School of Medicine
Robert A. Mulliken, Pritzker School of Medicine
Linda Lee, Pritzker School of Medicine
Sandeep Nathan, Pritzker School of Medicine
Jearlyn Nichols, The University of Chicago Medicine
John J. Lopez, Loyola University Stritch School of Medicine

Document Type

Journal Article

Publication Date

5-1-2012

Journal

Catheterization and Cardiovascular Interventions

Volume

79

Issue

6

DOI

10.1002/ccd.23221

Keywords

acute coronary syndrome; atypical angina; reperfusion; systems

Abstract

Objective: To assess a quality improvement initiative aimed at minimizing door-to-balloon (DTB) times for ST-elevation myocardial infarction (STEMI) patients presenting without chest pain. Background: Timely percutaneous coronary intervention (PCI) is the cornerstone of STEMI care. The absence of chest pain delays PCI. Improvements in DTB times may need to focus on atypical presentation patients. Methods: We compared DTB times on all STEMI patients admitted through the emergency department who underwent PCI before (Phase I; October 2004-June 2007) and after (Phase II; July 2007-October 2009) the quality improvement effort, which mandated rapid electrocardiogram (ECG) triage for an expanded list of presenting symptoms. Results: In Phase I (69 patient, 60 with chest pain), patients with chest pain had a shorter mean time to first ECG (ECG Interval) by 32.0 min (P < 0.01) and nonsignificantly faster mean DTB time by 42.0 min (P = 0.07) compared to patients who presented without chest pain. In Phase II (62 patients, 56 with chest pain) compared to Phase I, mean ECG interval decreased by 44 min (P = 0.02) and mean DTB time by 99 min (P = 0.01) in patients without chest pain, eliminating the differences in ECG intervals between typical and atypical presentations (12 min vs. 11 min, P = 0.91). Multivariable analysis controlling for on/off hours and patient characteristics confirmed these findings. Conclusions: A simple modification of emergency room ECG triage protocol, which expands indications for rapid ECG performance, was successful in improving rapid reperfusion for patients with STEMI presenting without chest pain. © 2011 Wiley-Liss, Inc.

APA Citation

Borden, W., Fennessy, M., O'Connor, A., Mulliken, R., Lee, L., Nathan, S., Nichols, J., & Lopez, J. (2012). Quality improvement in the door-to-balloon times for ST-elevation myocardial infarction patients presenting without chest pain. Catheterization and Cardiovascular Interventions, 79 (6). http://dx.doi.org/10.1002/ccd.23221