The network was a collaboration between an Emergency Department of a non-capable percutaneous coronary intervention (PCI) centre and a PCIable centre to enable access for ST elevation Myocardial Infarction (STEMI) patients for Primary Percutaneous Coronary Intervention (PPCI). The aim of the study is to determine if a protocol driven management of STEMI patient will improve the first medical contact (FMC) to balloon time with this network.
All STEMI patients had a focused history, examination and ECG performed. A standardized form was filled and the patients were managed as per local guidelines. Symptom onset to ED, door-in-door-out time (DIDO), PCI centre door-to-balloon time (D2B), first –medical-contact (FMC) to balloon and total ischemic time were collected. Inhospital and 30-day mortality rate at 30 days were also reported. The data derived were divided into two phases. This is to evaluate temporal improvements as the network matures.
150 patients were enrolled in the 13 month period (n=46 for phase A and n=104 for phase B). The DIDO for the first cohort was 44 minutes, IQR (30- 72) and this timing reduced significantly in the second cohort (30 minutes, IQR (24.5-50), P=0.043). The median FMC to balloon times also reduced significantly between the 2 phases (phase A, 111.5 minutes, IQR (95.75- 132.75) and phase B 88 minutes IQR (75-108). p<0.001). There was no difference between in-hospital deaths reported between the phases (8.7% vs 2.9%. P=0.202). Thirty-day mortality differences were also not significant (2.4% vs 2.0%, P=0.971).
A protocol-driven management of STEMI patients could improve system timings like the DIDO and the FMC to balloon times as the network “matures” with time. There were no significant differences observed in the in hospital death and 30-day mortality rate. Further study is required to evaluate the long term impact over of this strategy.