Ethnic minorities exhibit reduction in door-to-balloon time comparable to whites with a newly-implemented emergency physician activation protocol (Code-STEMI).
BACKGROUND
Studies have shown significant differences in door-to-balloon times (D2B) for ethnic minority patients (minorities) undergoing angioplasty for ST-elevation myocardial infarction (STEMI) compared to white patients (white). In this study, we evaluated the D2B for these groups before and after modification of the emergency protocol for STEMI.


METHODS
We compared D2B for 51 consecutive STEMIs during 2006, (serial activation protocol, SAP) with D2B times for 72 consecutive STEMI patients during 2007 when a "Code STEMI" (concurrent activation) protocol was instituted. Outcomes were D2B times in whites versus minorities, pre- and post-Code-STEMI, length of stay (LOS) and peak troponin I levels.


RESULTS
The median D2B time in the SAP group was 113 (whites) vs. 122 (minorities) minutes (p = 0.324), as compared to 74 (whites) vs. 78 (minorities) minutes (p = 0.324) in the Code STEMI group. The D2B for both groups was significantly reduced (p < 0.0001) with the use of Code STEMI. The median peak troponin I in the SAP group was 97 ng/mL (whites) vs. 78 ng/mL (minorities) (p = 0.084), as compared to 54 ng/mL (whites) vs. 29 ng/mL (minorities) (p = 0.084) for the Code STEMI group. LOS was 4.88 days (whites) vs. 4.39 days (minorities) (p = 0.84) in the SAP group, as compared to 3.7 days (whites) vs. 3.4 days (minorities) (p = 0.84) for the Code STEMI group, a significant change (p = 0.012) for both groups.


CONCLUSIONS
No ethnic disparity was observed in the mean D2B time, LOS and peak troponin I levels between whites and minorities; both groups demonstrated comparable improvement in all outcomes evaluated.
Al-Dehneh
Anthony
A
Department of Cardiology, Seton Hall University, St. Joseph's Regional Medical Center, Paterson, New Jersey 07503, USA.
Parikh
Rupen
R
Hamdan
Aiman
A
Konlian
Donna
D
Faillace
Robert
R
Debari
Vincent A
VA
Jimenez
Edward
E
Bikkina
Mahesh
M
D001741:Black or African American / Q000208:ethnology; D000368:Aged; D000800:Angioplasty, Balloon; D015906:Angioplasty, Balloon, Coronary; D001213:Asian / Q000208:ethnology; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000208:ethnology; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data*; D009203:Myocardial Infarction / Q000097:blood / Q000208:ethnology* / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013997:Time Factors; D019210:Troponin I / Q000097:blood; D044465:White People / Q000208:ethnology
D019210:Troponin I