Hospitals Should Aim for 'As Soon As Possible' Standard for Door-to-Balloon Time

Hospitals Should Aim for 'As Soon As Possible' Standard for Door-to-Balloon Time
Balloon time is measured in minutes from the time the patient arrives at the hospital with a heart attack [myocardial infarction] to the time appropriate coronary artery intervention is performed, usually with balloon dilation of the obstructed coronary artery via primary percutaneous coronary intervention, [PCI].

Any delay in door-to-balloon time is associated with higher mortality rates in patients undergoing PCI. Therefore hospitals should strive for times well under the recommended 90-minute benchmark, according to a thorough BMJ study. Using a national registry, researchers examined outcomes among nearly 44,000 patients who underwent PCI for ST-segment-elevation myocardial infarction. In particular, they looked at time from hospital arrival to first balloon inflation or device deployment, as well as mortality rates.

The median door-to-balloon time was 83 minutes. Patients who underwent PCI by 30 minutes had an adjusted mortality rate of 3.0%, while those with door-to-balloon times of 240 minutes had a mortality rate of 10.3%. The recommended 90-minute time yielded a mortality rate of 4.3%.The authors conclude that their data "support calls for an 'as soon as possible' standard for patients undergoing primary percutaneous coronary intervention."

The authors stated that any delay in primary percutaneous coronary intervention after a patient arrives at hospital is associated with higher mortality in hospital in those admitted with ST elevation myocardial infarction. Time to treatment should be as short as possible, even in centres currently providing primary percutaneous coronary intervention within 90 minutes Clinical guidelines recommend that hospitals providing primary percutaneous coronary intervention to patients with ST segment elevation myocardial infarction should treat patients within 90 minutes of contact with the medical system or admission to hospital.

SUMMARY:
What is already known on this topic
Clinical guidelines recommend that hospitals providing primary percutaneous coronary intervention to patients with ST segment elevation myocardial infarction treat within 90 minutes of contact with the medical system or admission to hospital
The specific shape of the relation between mortality risk and time to treatment, and the incremental benefit of reductions in door-to-balloon times beyond 90 minutes, is unclear

What this study adds
Any delay in door-to-balloon time for patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention is associated with higher mortality, even among patients treated within 90 minutes of admission
Reducing door-to-balloon time to the greatest extent possible for all patient, including those currently treated within 90 minutes of admission, might reduce mortality

* Tune in tomorrow to find out America's other drug problem

Deepen your understanding of How to Be an Effective Medical Expert www.medmalbook.com