title: Reduced door-to-balloon times in acute ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.
abstract: BACKGROUND
  Primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) significantly reduces mortality and morbidity, particularly when door-to-balloon (D2B) time is < 90 min. We sought to minimize preventable delays by instituting an on-site cardiology team-based approach in the emergency department (ED).
  
  
  METHODS
  The on-site group comprised 146 consecutive patients with STEMI undergoing primary PCI after implementation of the on-site strategy. This new patient care model was compared with the conventional care administered before instituting the on-site cardiology team-based strategy in ED, which included 90 patients (interim group) receiving primary PCI at a catheterization room in the same building as the ED, and 147 patients (pre-on-site group) undergoing primary PCI at a catheterization room two blocks away from the ED.
  
  
  RESULTS
  Median D2B time decreased from 107 min in the pre-on-site group to 72 min in the interim group, and to 47 min in the on-site group, respectively (p < 0.001). The percentage of D2B times < 90 min increased from 34% to 78% and 96%, respectively among the three groups (p < 0.001). Hospitalization costs were significantly reduced in the on-site and interim vs. pre-on-site groups ($5944, $5999, and $6581, respectively; p = 0.008). In-hospital mortality did not differ significantly among the three groups (4.8%, 2.2%, and 6.1%, respectively; p = 0.387).
  
  
  CONCLUSIONS
  Institution of an on-site cardiology team-based approach in the ED significantly reduces D2B time in STEMI patients eligible for primary PCI.
authors.affiliation: Division of Cardiology, Department of Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Y-C
authors.initials: YC
authors.lastname: Wang
authors.forename: P-H
authors.initials: PH
authors.lastname: Lo
authors.forename: S-S
authors.initials: SS
authors.lastname: Chang
authors.forename: J-J
authors.initials: JJ
authors.lastname: Lin
authors.forename: H-J
authors.initials: HJ
authors.lastname: Wang
authors.forename: C-P
authors.initials: CP
authors.lastname: Chang
authors.forename: L-C
authors.initials: LC
authors.lastname: Hsieh
authors.forename: Y-P
authors.initials: YP
authors.lastname: Chen
authors.forename: W-K
authors.initials: WK
authors.lastname: Chen
authors.forename: C-H
authors.initials: CH
authors.lastname: Chen
authors.forename: K-C
authors.initials: KC
authors.lastname: Chang
authors.forename: J-S
authors.initials: JS
authors.lastname: Hung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000592:standards* / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D010360:Patient Transfer / Q000592:standards* / Q000706:statistics & numerical data; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome