BackgroundA main outcome determinant after percutaneous coronary intervention(PCI) for ST-segment elevation acute myocardial infarction(STEMI) is the door-to-balloon time(DBT). The current AHA/ACC guidelines promotes a DBT within 90±30 minutes as a target for quality. We could achieve this goal by quality intervention involving the simplification of notify system, which was combined with transmission of a 12-lead electrocardiogram(ECG) with digital camera phone.MethodWe implemented this quality intervention from February 2005. The physician who first noticed the STEMI transmitted two ST elevated lead in 12-lead ECG with digital camera phone to interventional cardiologist. After confirmation, primary PCI process was initiated including direct notification to cath lab team and cardiology fellow. We compared DBT between the pre- and post-quality intervention periods. We also subdivide DBT into door-to-ECG, ECG-to-notify, notify-to-cath lab, and cath lab-to-balloon subinterval and compared indivisually.ResultPrimary PCI was undertaken for STEMI in the pre- and post-quality intervention periods in 43 and 18 consecutive patients, respectively. Prior to quality intervention, the mean DBT at baseline was 146±62minutes. After intervention the mean DBT was significantly decreased to 98±28minutes(p=0.006). Similarly, there was marked improvement in the number of patients receiving PCI by 120 minutes after intervention compared with the baseline(46.5% vs. 72.2%, p=0.004). The reduction in ECG-to-cath lab subinterval was most striking and resulted in reduction in DBT(46minutes vs. 15minutes,p<0.001).ConclusionOur quality improvement efforts resulted in a dramatic reduction in DBT, especially in ECG-to-notify subinterval.
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