Impact of Routine Case Volume on Door-to-Device Time for Primary PCI Patients: The Concept of a Designated Primary PCI Cath Lab at a Large Volume Cardiac Center
Article Sidebar
Main Article Content
Abstract
Background: Timely management of acute ST-elevation myocardial infarction (STEMI) is crucial, as prolonged door-to-device (DTD) time is directly related to worse cardiac outcomes. Institutions aim to achieve optimal DTD times as a measure of quality improvement.
Objective: This study aimed to evaluate the impact of a higher number of routine cases on the DTD time of acute STEMI patients presenting to a tertiary care cardiac center.
Methods: This retrospective observational study was conducted at the Peshawar Institute of Cardiology (PIC) in Peshawar. A total of 371 patients presented with acute STEMI over a three-month period, of whom 258 were included in the detailed analysis. Patient data, including baseline characteristics, arrival time, and device time, were obtained from the hospital database. Patients were divided into three groups based on their presentation timing: Morning (08:00 am to 02:00 pm), Evening (02:00 pm to 08:00 pm), and Night (08:00 pm to 08:00 am). The primary endpoint was to calculate and compare DTD time between these groups and evaluate the impact of routine case volume, especially during daytime hours.
Results: Out of the 258 patients studied, 194 (75.4%) were male, with a mean age of 58.2 ± 11.2 years. Hypertension was the most common risk factor, affecting 131 patients (50.7%). A higher number of cases presented during the night shift (n=99), followed by the evening (n=81) and morning shifts (n=78). The use of conventional right radial artery access (RRAA) was prevalent (n=239, 92.6%, p=0.032). The total mean DTD time was 90.78 ± 39.9 minutes, with shift-wise DTD times of 74.0 ± 29.6 minutes for the night shift, 98.97 ± 40.0 minutes for the evening shift, and 103.5 ± 44.0 minutes for the morning shift. Post-procedural TIMI-III flow was achieved in 90.9% of night shift patients, 86.4% of evening shift patients, and 82.0% of morning shift patients.
Conclusion: A higher number of routine cases resulted in prolonged DTD time. Establishing a designated catheterization lab exclusively for primary PCIs could improve DTD times and patient outcomes.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Park J, Choi KH, Lee JM, Kim HK, Hwang D, Rhee TM, et al. Prognostic Implications of Door-to-Balloon Time and Onset-to-Door Time on Mortality in Patients With ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention. J Am Heart Assoc. 2019;8(9).
Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, et al. ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). J Am Coll Cardiol. 2004;44(3).
Ryan TJ, Antman EM, Brooks NH, Califf RM, Hillis LD, Rapaport E, et al. 1999 Update: ACC/AHA Guidelines for the Management of Patients With Acute Myocardial Infarction: Executive Summary and Recommendations: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). Circulation. 1999;100(9):1016-30.
Krumholz HM, Bradley EH, Nallamothu BK, Ting HH, Batchelor WB, Kline-Rogers E, et al. A Campaign to Improve the Timeliness of Primary Percutaneous Coronary Intervention: Door-to-Balloon: An Alliance for Quality. JACC Cardiovasc Interv. 2008;1(1):97-104.
Jacobs AK, Antman EM, Ellrodt G, Faxon DP, Gregory T, Solis P, et al. Recommendation to Develop Strategies to Increase the Number of ST-Segment Elevation Myocardial Infarction Patients With Timely Access to Primary Percutaneous Coronary Intervention. Circulation. 2006;113(17):2152-63.
Lai CL, Fan CM, Liao PC, Li PY, Lin LJ, Chi CL. Impact of an Audit Program and Other Factors on Door-to-Balloon Times in Acute ST-Elevation Myocardial Infarction Patients Destined for Primary Coronary Intervention. Acad Emerg Med. 2009;16(4):333-42.
Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, et al. ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: Executive Summary. J Am Coll Cardiol. 2004;44(3):671-719.
Antman EM, Hand M, Armstrong PW, Bates ER, Green LA, Halasyamani LK, et al. 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the Canadian Cardiovascular Society and Endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee. Circulation. 2008;117(2):296-329.
Marcusohn E, Reiner Benaim A, Ronen S, Kerner A, Beyar R, Almog R. Door-to-Balloon Time in Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction: Every Minute Counts. Coron Artery Dis. 2022;33(5):341-8.
Reffelmann T, Kloner RA. The "No-Reflow" Phenomenon: Basic Science and Clinical Correlates. Heart. 2002;87(2):162-8.
Şahin DY, Gür M, Elbasan Z, Kuloğlu O, Çaylı M, Yiğit F, et al. SYNTAX Score Is a Predictor of Angiographic No-Reflow in Patients With ST-Elevation Myocardial Infarction Treated With a Primary Percutaneous Coronary Intervention. Coron Artery Dis. 2013;24(2):148-53.
Harrison RW, Aggarwal A, Ou FS, Klein LW, Rumsfeld JS, Roe MT, et al. Incidence and Outcomes of No-Reflow Phenomenon During Percutaneous Coronary Intervention Among Patients With Acute Myocardial Infarction. Am J Cardiol. 2013;111(2):178-84.
Romagnoli E, Biondi-Zoccai G, Sciahbasi A, Politi L, Rigattieri S, Pendenza G, et al. Radial Versus Femoral Randomized Investigation in ST-Segment Elevation Acute Coronary Syndrome: The RIFLE-STEACS Study. J Am Coll Cardiol. 2012;60(24):2481-9.
Dworeck C, Redfors B, Völz S, Angerås O, Odenstedt J, Ioanes D, et al. Radial Artery Access Is Associated With Lower Mortality in Patients Undergoing Primary PCI: A Report From the SWEDEHEART Registry. Eur Heart J Acute Cardiovasc Care. 2020;9(4):323-32.
Kimura K, Kimura T, Ishihara M, Nakagawa Y, Nakao K, Miyauchi K, et al. JCS 2018 Guideline on Diagnosis and Treatment of Acute Coronary Syndrome. Circ J. 2019;83(5):1085-96.
Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS Guidelines on Myocardial Revascularization. Eur Heart J. 2019;40(2):87-165.
Shoji S, Kohsaka S, Kumamaru H, Sawano M, Numasawa Y, Ueda I, et al. Cost Reduction Associated With Transradial Access in Percutaneous Coronary Intervention: A Report From a Japanese Nationwide Registry. Lancet Reg Health West Pac. 2022;28:100555.