Door-to-Balloon

Times in Interfacility Transports of STEMI Pa7ents

Lindsay McFarlane, Thomas Kwiatkowski, MD, Mae Ward, RN

Hofstra North Shore-LIJ School of Medicine, North Shore-LIJ Health System

Current recommenda-ons state that pa-ents who

receive percutaneous interven-on (PCI) to treat ST-
segment-eleva-on myocardial infarc-on (STEMI) should
receive PCI less than 90 minutes aCer the ini-al pa-ent
contact with the health system1. The measurement of
the interval between ini-al pa-ent contact and balloon
angioplasty (PCI) is Door-to-Balloon -me. If achieving a
Door-to-Balloon -me under 90 minutes is not possible,
pa-ents with STEMI should receive brinoly-c therapy
within 30 minutes of contact with the health system1.
Evalua-on of compliance with these recommenda-ons is
largely based on pa-ents who present to an ED in the
same hospital that can perform PCI. However, pa-ents
who present to an ED at a hospital without PCI
capabili-es must be transferred to a PCI-capable facility
but s-ll must strive to meet the 90-minute Door-to-
Balloon -me recommenda-on.
The purpose of this study is to evaluate the Door-to-
Balloon -mes in STEMI pa-ents transferred from non-PCI-
capable community hospitals to PCI-capable centers.

Results

Can PCI be achieved in <90 minutes?

Median Time Intervals in Door-to-Balloon Cases

No

100

80

68

60
40
20

30

40
14

12

15

13

Methods
This study was a retrospec-ve chart review of pa-ents
transported from ve community hospitals to two ter-ary
care centers within the North Shore-LIJ Health System in
the years 2010 and 2011. Only pa-ents who were
transferred directly from the community hospital ED and
immediately received PCI at the ter-ary care center were
included in the study, resul-ng in a total of 180 pa-ents.
A Data Collec-on Tool (DCT) was designed for this study
to allow for documenta-on of several important -me
intervals from ini-al presenta-on to the emergency
department, interfacility transport by EMS, to balloon
ina-on -me at the catheteriza-on lab. Mee-ngs were
held at the ve community hospitals to standardize data
collec-on.

Yes

116

120

Minutes

Introduc7on

Preliminary analysis was performed by aggrega-ng data from all ve community hospitals and
both ter-ary care centers. The median Door-to-Balloon -me for STEMI transfer pa-ents was
116 minutes. Specic -me intervals are displayed below. The median total -me spent at the
community hospital was 68 minutes.
64% of pa-ents arrived via private transporta-on and 36% arrived by ambulance. Table 1
displays the characteris-cs of our study popula-on.
Further data analysis addressing other pre-specied variables is currently ongoing.

Conclusions

Median Age

58.5 years

Gender(%)

Male (142) 78.9%

Race(%)

Asian(3) 1.6%
Black(19) 10.5%
Hispanic(12) 6.7%
White(121) 67.2%
Other(15) 8.3%
No data(10) 5.6%

Chief Complaint Chest Pain(155) 86.1%

(%)
No Chest Pain(25) 13.9%
Table 1

Arrival Mode

Ambulance
36%
Walk In
64%

This retrospec-ve analysis suggests that there are

opportuni-es for improvement for STEMI pa-ents who
require interfacility transport to a STEMI center. Ongoing
analysis will specify Door-to-Balloon -me intervals by
individual hospital in order to beaer understand barriers
encountered by each facility in achieving recommended
Door-to-Balloon -mes. Our goal is to work with each
hospital to develop hospital-specic and health system-
wide interven-ons to reduce the Door-to-Balloon -mes
in STEMI interfacility transfers. We also intend to
perform a prospec-ve study aCer the interven-ons are
implemented to evaluate improvement in Door-to
Balloon -me.
Addi-onally, the data regarding arrival mode of STEMI
pa-ents reveals that con-nued community educa-on
and awareness is important to encourage the early use of
EMS in cardiac emergencies instead of using private
transporta-on to the ED (walk-in). This is especially
important in light of EMS specialty designa-on of
hospitals as STEMI Centers.

Bibliography
1. ACC/AHA Guidelines for the Management of Pa-ents with ST-
Eleva-on Myocardial Infarc-on Execu-ve Summary : A Report of
the ACC/AHA Task Force on Prac-ce Guidelines. Circula(on. 2004;
110:588-636.