Superior outcome with direct catheter laboratory access vs ED-activated primary percutaneous coronary intervention.
OBJECTIVE
Admitting patients directly to a heart attack center (HAC) catheter laboratory for primary percutaneous coronary intervention (PPCI) bypassing the emergency department (ED) might be beneficial in delivering treatment of ST-elevation myocardial infarction with superior outcome.


METHODS
In this analysis, the clinical outcome of service redesign of the PPCI pathway from ED triggered to a direct catheter laboratory HAC access was assessed in 361 consecutive patients with ST-elevation myocardial infarction treated with a PPCI.


RESULTS
A total of 200 patients were admitted via the ED, and 161 were admitted directly to the HAC. Door-to-balloon times and call-to-balloon times were significantly better in the HAC group (median [interquartile range] door-to-balloon times and call-to-balloon times were 39 [26, 53] and 106 [91, 132] minutes, respectively) in comparison with the ED group (82 [49,120; P < .0001] and 130 [103, 164] minutes, respectively [P = .0005]). A nonsignificant trend to a lower 30-day (5% in the HAC group and 6% in the ED group) and 17-month (8% in HAC group and 11% in ED group) mortality was seen in the HAC group (P = .63). Composite end point analysis of left ventricular ejection fraction less than 50%, thrombolysis in myocardial infarction grades 0 and 1, and myocardial blush scores 0 and 1 showed that a significantly higher number of patients in the ED group experienced at least 1 of the composite events in comparison with the patients in the HAC group (P = .01).


CONCLUSIONS
A direct-access catheter laboratory (HAC) model of PPCI bypassing the ED should be the favored approach to service delivery with superior outcome.
Department of Cardiology, University Hospital Wales, Cardiff, CF14 4XW, UK. bikashmaj@hotmail.com
Bikash
B
Majumder
Chrysostomos
C
Mavroudis
Colette
C
Smith
John G
JG
Coghlan
ManFai
M
Shiu
Roby D
RD
Rakhit
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D006328:Cardiac Catheterization / Q000379:methods*; D003325:Coronary Care Units / Q000458:organization & administration; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors