title: Simultaneous computerised activation of the primary percutaneous coronary intervention pathway reduces out-of-hours door-to-balloon time but not mortality.
abstract: BACKGROUND
  In 2009 activation of out of hours (OOH) primary percutaneous coronary intervention (PPCI) in our institution changed from separate telephone calls to a simultaneous computerised alert. We assessed the impact of this protocol change on door-to-balloon (DTB) time, in hospital and 1 year mortality.
  
  
  METHODS
  Retrospective survey of our Myocardial Ischaemia National Audit Project (MINAP) database. OOH patients were categorized--pre- (Group 1) and post- (Group 2) introduction of the computerised alert protocol.
  
  
  RESULTS
  OOH PPCI was performed for 793 patients (mean age 61, 73.4% male)--295 in Group 1 and 498 in Group 2. Median DTB times were 92 min (interquartile range [IQR] 75-111) for Group 1 and 76 min (IQR 64-97) for Group 2 (p < 0.0001). Forty-eight percent achieved DTB in ≤ 90 min in Group 1 compared to 70% in Group 2 (p < 0.0001). Computerised alert was associated with a shorter DTB time on multivariate analysis (beta coefficient -0.09, p = 0.03 for linear regression and OR 2.8, 95% CI 1.6-5.0, p < 0.0001 for logistic regression). In hospital mortality was 4.1% in Group 1 and 5% in Group 2 (p = 0.60). All-cause mortality at 1 year was 6.1% in Group 1 and 9.9% in Group 2 (p = 0.09).
  
  
  CONCLUSIONS
  Simultaneous computerised activation for OOH PPCI reduced DTB times, increased the number of patients achieving target DTB times but did not affect mortality.
authors.affiliation: University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom.
authors.forename: R A
authors.initials: RA
authors.lastname: Brown
authors.affiliation: Cardiology Department at Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, Birmingham and Sandwell Hospital, West Bromwich, United Kingdom.
authors.forename: C
authors.initials: C
authors.lastname: Varma
authors.affiliation: Cardiology Department at Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, Birmingham and Sandwell Hospital, West Bromwich, United Kingdom.
authors.forename: D L
authors.initials: DL
authors.lastname: Connolly
authors.affiliation: Cardiology Department at Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, Birmingham and Sandwell Hospital, West Bromwich, United Kingdom.
authors.forename: R
authors.initials: R
authors.lastname: Ahmad
authors.affiliation: University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom; Cardiology Department at Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, Birmingham and Sandwell Hospital, West Bromwich, United Kingdom.
authors.forename: E
authors.initials: E
authors.lastname: Shantsila
authors.affiliation: University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom; Cardiology Department at Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, Birmingham and Sandwell Hospital, West Bromwich, United Kingdom. Electronic address: g.y.h.lip@bham.ac.uk.
authors.forename: G Y H
authors.initials: GY
authors.lastname: Lip
mesh_terms: D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D061665:Time-to-Treatment / Q000458:organization & administration*; D014187:Transportation of Patients / Q000592:standards*; D006113:United Kingdom / Q000453:epidemiology
keywords: Door-to-balloon time; Out-of-hours; Primary percutaneous coronary intervention; ST-segment elevation myocardial infarction