Strategies for Reducing the Door-to-Balloon Time in Acute Myocardial Infarction

• Published in: The New England journal of medicine Vol. 355; no. 22; pp. 2308 - 2320
• Main Authors: Bradley, Elizabeth H, Herrin, Jeph, Wang, Yongfei, Barton, Barbara A, Webster, Tashonna R, Mattera, Jennifer A, Roumanis, Sarah A, Curtis, Jeptha P, Nallamothu, Brahmajee K, Magid, David J, McNamara, Robert L, Parkosewich, Janet, Loeb, Jerod M, Krumholz, Harlan M
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 30.11.2006
• Subjects: Angioplasty, Balloon, Coronary - standards; Biological and medical sciences; Cardiology. Vascular system; Confidence intervals; Coronary heart disease; Cross-Sectional Studies; Electrocardiography; Emergency medical care; Emergency Medical Services - organization & administration; Emergency Medical Services - standards; Emergency Service, Hospital - organization & administration; General aspects; Generalized linear models; Heart; Heart attacks; Hospitals; Humans; Linear Models; Medical research; Medical sciences; Multivariate Analysis; Myocardial Infarction - therapy; Time Factors; Variables; Myocardial infarction; Medicine; Heart disease; Acute; Sounding balloon; Cardiovascular disease; Strategy; Myocardial disease
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMsa063117

Hospitals have a variety of strategies to reduce the time from arrival at the hospital to intracoronary balloon inflation (door-to-balloon time) for patients who have acute myocardial infarction with ST-segment elevation. In a study of 365 hospitals, 28 institutional strategies were identified with the use of a field-tested questionnaire. These strategies were correlated with door-to-balloon times for individual patients as reported to the Centers for Medicare and Medicaid Services. Six strategies were associated with a significant reduction in the door-to-balloon time. The use of these strategies may improve outcomes for patients. In a study of 365 hospitals, six strategies were associated with a significant reduction in the door-to-balloon time. The use of these strategies may improve outcomes for patients. Prompt treatment increases the likelihood of survival for patients who have myocardial infarction with ST-segment elevation. 1 – 3 Hospitals can therefore influence the outcomes for such patients by developing and implementing systems and processes that minimize the interval between arrival at the hospital and the administration of reperfusion therapy. Since percutaneous coronary intervention (PCI) has become the preferred approach for treating myocardial infarction with ST-segment elevation, 4 hospitals are seeking ways to reduce the door-to-balloon time, defined as the time between arrival at the hospital and the first balloon inflation during PCI. The importance of the door-to-balloon time is highlighted by its . . .