Background Early application of primary percutaneous coronary intervention (PCI) can maximize the efficacy of reperfusion therapy in patients with ST elevation myocardial infarction (STEMI). Shortening of time delay to 1st balloon time can make better improved outcome such as impaired left ventricular systolic function and death. We organized AMI team and changed the notification cascade to improve the in-hospital time delay. And then, We had regular case conferences and reviewed the causes of delayed cases with emergency physicians. Therefore, we performed this study to evaluate in-hospital time delay among three phases (Classic notifying system, Modified notifying system and Conference feedback system).
Methods We analyzed 28 patients received primary PCI from March to June 2006 (phase I, before AMI team organization), 35 patients from March to June 2007(phase II, after AMI team organization) and 45 patients from March to June 2008 (phase III, after Conference). We analyzed various time delays from Symptom to door time, door to cathroom arrival time, cathroom arrival to 1st balloon time and door to 1st balloon time.
Results : The mean age(phase I, phase II and phase III) were 66.6 ± 11.6 years, 61.1 ± 11.6 years and 62.8 ± 14.1 years (p=0.223). Symptom to door time (phase I, phase II and phase III) were 360.82 ± 259.27 minutes, 252.06 ± 230.18 minutes and 308.71 ± 372.53 minutes(p=0.370), door to cathroom arrival time(phase I, phase II and phase III) 76.44 ± 32.48 minutes, 51.53 ± 38.83 minutes and 47.51 ± 15.01 minutes(p=0.002), cathroom arrival to 1st balloon time (phase I, phase II and phase III) 21.29 ± 9.57 minutes, 22.29 ± 10.84 minutes and 19.64±10.20 minutes (p=0.511), door to 1st balloon time(phase I, phase II and phase III) 98.61±34.85 minutes, 73.34±41.33 minutes and 67.15±17.90 minutes(p=0.002).
Conclusions The organization of AMI team including the simplification of the notification system improved in-hopital time delay. Moreover, Conference feedback system better improved in-hospital time delay, especially door to cathroom time.
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