Simultaneous computerised activation of the primary percutaneous coronary intervention pathway reduces out-of-hours door-to-balloon time but not mortality. (1st May 2015)

• Record Type: Journal Article
• Authors: Brown, R.A.; Varma, C.; Connolly, D.L.; Ahmad, R.; Shantsila, E.; Lip, G.Y.H.
• Is Part Of: International journal of cardiology. Volume 186(2015)
• Page Start: 226
• Page End: 230
• Publication Date: 2015-05-01
• Subjects: Door-to-balloon time -- Out-of-hours -- Primary percutaneous coronary intervention -- ST-segment elevation myocardial infarction; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2015.03.172
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: In 2009 activation of out of hours (OOH) primary percutaneous coronary intervention (PPCI) in our institution changed from separate telephone calls to a simultaneous computerised alert. We assessed the impact of this protocol change on door-to-balloon (DTB) time, in hospital and 1 year mortality. Methods: Retrospective survey of our Myocardial Ischaemia National Audit Project (MINAP) database. OOH patients were categorised — pre- (Group 1) and post- (Group 2) introduction of the computerised alert protocol. Results: OOH PPCI was performed for 793 patients (mean age 61, 73.4% male) — 295 in Group 1 and 498 in Group 2. Median DTB times were 92 min (interquartile range [IQR] 75–111) for Group 1 and 76 min (IQR 64–97) for Group 2 (p < 0.0001). Forty-eight percent achieved DTB in ≤ 90 min in Group 1 compared to 70% in Group 2 (p < 0.0001). Computerised alert was associated with a shorter DTB time on multivariate analysis (beta coefficient − 0.09, p = 0.03 for linear regression and OR 2.8, 95% CI 1.6–5.0, p < 0.0001 for logistic regression). In hospital mortality was 4.1% in Group 1 and 5% in Group 2 (p = 0.60). All-cause mortality at 1 year was 6.1% in Group 1 and 9.9% in Group 2 (p = 0.09). Conclusions: Simultaneous computerised activation for OOH PPCI reduced DTB times, increased the number of patients achieving target DTB times but did not affect mortality.