title: Reduction of delays in primary percutaneous coronary intervention.
abstract: BACKGROUND
  Acute myocardial infarction is a major health issue. Primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction was proved to be superior to fibrinolytic therapy in many randomized trials when done in a timely manner. However, PPCI is associated with delays. Studies have shown that greater delay is associated with increased mortality rate. We applied simple interventions to reduce door-to-balloon time. Our study goal was to evaluate the reduction of delays after our interventions and to monitor 30-day mortality.
  
  
  METHODS
  A prospective registry was created to evaluate delays and mortality associated with PPCI. Measures such as annual feedback with suggestions were taken to minimize the delays. Door-to-balloon delays before and after the interventions were compared.
  
  
  RESULTS
  A total of 1361 primary PCIs were performed from 2005 to 2008. Of these cases, 1071 patients were transferred from community hospitals. The median door-to-balloon time for transferred patients was 142 minutes for 2005, 138 minutes for 2006, 125 minutes for 2007, and 121 minutes for 2008 (P < 0.001 for 2005 vs. 2008). Door-to-balloon time for patients admitted directly to our centre was 87 minutes in 2005, 74.5 minutes in 2006, 73.5 minutes in 2007, and 74.0 minutes in 2008 (P < 0.001 for 2005 vs. 2008). Thirty-day mortality of these consecutive patients is low (5.2% for 2005 and 3.8% for 2008; P = not significant).
  
  
  CONCLUSIONS
  Inexpensive and simple interventions may significantly reduce primary PCI-related delays for transferred cases and patients admitted directly to a centre with PPCI facilities. We also observed a low mortality rate for those consecutive patients.
authors.affiliation: Department of Medicine, Sherbrooke University, Sherbrooke, Québec, Canada.
authors.forename: Benoit
authors.initials: B
authors.lastname: Daneault
authors.forename: Doan Hoa
authors.initials: DH
authors.lastname: Do
authors.forename: Andrée
authors.initials: A
authors.lastname: Maltais
authors.forename: Simon
authors.initials: S
authors.lastname: Bérubé
authors.forename: Richard
authors.initials: R
authors.lastname: Harvey
authors.forename: André
authors.initials: A
authors.lastname: Gervais
authors.forename: Karl
authors.initials: K
authors.lastname: Dalery
authors.forename: Michel
authors.initials: M
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D010360:Patient Transfer; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome