Author + information
- Received January 18, 2010
- Revision received May 31, 2010
- Accepted June 6, 2010
- Published online January 18, 2011.
- James C. Blankenship, MD⁎,⁎ (, )
- Thomas D. Scott, DO⁎,
- Kimberly A. Skelding, MD⁎,
- Thomas A. Haldis, DO†,
- Karen Tompkins-Weber, RN⁎,
- Marie Y. Sledgen, RN⁎,
- Michael A. Donegan, DO‡,
- Jeremy W. Buckley, MD§,
- Jennifer A. Sartorius, MS∥,
- John McB. Hodgson, MD⁎ and
- Peter B. Berger, MD⁎
- ↵⁎Reprint requests and correspondence:
Dr. James C. Blankenship, Department of Cardiology 21-60, Geisinger Medical Center, 100 North Academy Drive, Danville, Pennsylvania 17822
Objectives The purpose of this study was to demonstrate the feasibility of routine transfer of ST-segment elevation myocardial infarction (STEMI) patients to achieve percutaneous coronary intervention (PCI) in less than 90 min from presentation.
Background Many PCI hospitals have achieved routine door-to-balloon times under 90 min for patients with STEMI presenting directly to the hospital. However, few patients transferred from a non-PCI center undergo PCI within 90 min of presentation.
Methods Our rural PCI hospital implemented a program in 2005 for rapid triage, transfer, and treatment of STEMI patients and made additional improvements in 2006 and 2007. Intervals between milestones in the STEMI triage/transfer/treatment process were assessed before and after implementation of the program.
Results During the 5-year study period, 676 patients with 687 STEMIs were transferred from 19 community hospitals and underwent PCI. Median door-to-balloon time decreased from 189 min to 88 min (p < 0.001). The time intervals reflecting efficiency of the referring hospitals, transfer services, and PCI hospital all significantly improved. In 2008, median door-to-balloon times were <90 min for 6 of the 7 most frequently referring hospitals. Delays during off-hours presentation in 2004 were abolished after the program was implemented in 2005. In-hospital mortality decreased from 6% before to 3% after implementation of the program. In multivariate modeling, presentation before initiation of the STEMI program predicted increased risk of in-hospital mortality (odds ratio: 3.74, 95% confidence interval: 1.22 to 11.51, p = 0.021).
Conclusions A program of rapid triage, transfer, and treatment of STEMI patients presenting to non-PCI hospitals can reduce in-hospital mortality and produce progressive improvements in door-to-balloon time such that median door-to-balloon times under 90 min are feasible.
Funding for statistical analyses was provided by the Clinical Endowment for Research of the Geisinger Health System. Dr. Skelding has DSMB and Educator relationships with Medtronic. Dr. Berger has served as a consultant to AstraZeneca, Boehringer Ingelheim, and Eli Lilly/Daiichi Sankyo; and has received research funding from AstraZeneca, Corgenix/Aspirinworks, Eli Lilly/Daiichi Sankyo, Haemoscope, Helena, The Medicines Company, and Thrombovision. All other authors have reported that they have no relationships to disclose.
- Received January 18, 2010.
- Revision received May 31, 2010.
- Accepted June 6, 2010.
- American College of Cardiology Foundation