Author + information
- Orlando Rodriguez-Vilaa,b,
- Miguel A. Camposa,b,
- Fernando Lapetinaa,b,
- Jose Escabia,b,
- Carlos Nievesa,b,
- Edgardo Bermudeza,b,
- Juan C. Zevallosa,b and
- Sameer Mehtaa,b
Healthcare funding is lower in the US territories compared to the US states. National initiatives led to marked improvements in the timeliness of angioplasty (PCI) for acute ST-segment elevation myocardial infarction (STEMI) in the US states from 2005 to 2010 but not in Puerto Rico, despite having PCI hospitals within a one-hour range.
In 2010, we organized the Puerto Rico Infarction National Collaborative Experience (PRINCE) initiative, a physician-driven effort to reduce door-to-balloon (D2B) time in hospitals with 24/7 PCI capability across the island. Process improvement interventions included developing a data collection structure, guiding the implementation of known best practices, and promoting pre-hospital electrocardiography and transmission in ambulances. Patients within 12 hours of an acute STEMI referred for primary PCI were enrolled in a registry. The primary endpoint was change in D2B time over the 3 years post intervention as compared to a historical control.
Four of the eight PCI-capable centers participated in PRINCE. During the first year alone, median D2B improved from 130 to 69 minutes and the %D2B <90 minutes from 24% to 71%. Benefit was sustained in years two and three. A nearly 5% absolute decrease in in-hospital mortality was not statistically significant.
In spite of a healthcare funding disadvantage, a physician-guided alignment of available PCI resources can exert a rapid and sustainable impact in the timeliness of STEMI-PCI.
|STEMI-PCI Performance Before and After PRINCE|
|Historical Control Before 2011||PRINCE Cohort 2012-2014||p Value|
|In-Hospital Mortality (%)||11.9||7.1||0.26|
|Median D2B Time (minutes)||130||62||<0.0001|
|% D2B Time <90 minutes||23.8||78.9||<0.0001|
|% D2B Time <75 minutes||11.9||63||<0.0001|
Poster Area, South Hall A1
Sunday, April 03, 2016, 3:45 p.m.-4:30 p.m.
Session Title: Acute Coronary Syndromes: Implementing the Known and the Novel to Improve Outcomes
Abstract Category: 15. Acute Coronary Syndromes: Therapy
Presentation Number: 1215-012
- 2016 American College of Cardiology Foundation