TY - JOUR
T1 - Optimizing primary PCI beyond "door to intervention time"-are we there yet?
AU - Kaluski, Edo
AU - Maher, James
AU - Gerula, Christine
AU - Tsai, Steve
AU - Randhawa, Preet
AU - Saric, Muhamed
AU - Oghlakian, Gerard
AU - Alfano, Diane
AU - Palmaro, Jack
AU - Haider, Bunyad
AU - Klapholz, Marc
PY - 2010/4
Y1 - 2010/4
N2 - Aim: To assess the effects of shortened door-to-intervention (DTI) time on appropriate clinical decisions regarding the four most critical and costly decisions during primary percutaneous coronary intervention (PCI): cath-lab activation (CLA), use of glycoprotein IIb/IIIa inhibitors (GPI), use of PCI, and deployment of drug-eluting stent (DES). Background: STEMI PCI patients are frequently subject to decision making based on abbreviated medical encounter and limited medical information. Methods: Clinical data were prospectively collected in a STEMI registry over 19 months. Retrospective chart reviews were conducted to determine the level of appropriateness of the above-mentioned decisions. Results: Between June 2006 and December 2007, 200 EKGs with suspected STEMI were transmitted; 88 (44%) resulted in CLA. Compared to prior year, DTI times decreased from 145.7 to 69.9 min (P=.00001). DTI was longer during nights and weekends (87.5 vs. 51.8 min, P=.001) and the initial 6 months of the registry (86.8 vs. 66.8 min, P=.07). Nineteen (21.6%) of the patients undergoing angiography did not require revascularization, 56 (63.6%) received GPIs, and 65 patients (73.8%) underwent at least one vessel PCI, and at least one DES was used in 39 patients (60% of PCI cohort). When assessed for appropriateness, CLA was appropriate in 81.8% of the time and rendered borderline or inappropriate in 5.7% and 12.5%, respectively. GPI use was appropriate in 66% of the patients but seemed borderline or inappropriate in 28.5% and 5.4%, respectively. PCI was appropriate in 90% of the lesions treated, and borderline or inappropriate in 7.1% and 2.9%, respectively. DES use was viewed appropriate in 38.4%, and borderline or inappropriate in 51% and 10.2% of the DES deployments, respectively. Conclusions: (1) In view of expedited care, certain information required for decision-making process is either not available or ignored during primary PCI. (2) Appropriate use of resources in primary PCI needs to be better defined. (3) Measures of extracting patients' previous medical records and imaging studies along with in-lab immediate blood work and echocardiography and establishing new "time-out" protocols for STEMI patients may improve resource utilization and patient care and outcome.
AB - Aim: To assess the effects of shortened door-to-intervention (DTI) time on appropriate clinical decisions regarding the four most critical and costly decisions during primary percutaneous coronary intervention (PCI): cath-lab activation (CLA), use of glycoprotein IIb/IIIa inhibitors (GPI), use of PCI, and deployment of drug-eluting stent (DES). Background: STEMI PCI patients are frequently subject to decision making based on abbreviated medical encounter and limited medical information. Methods: Clinical data were prospectively collected in a STEMI registry over 19 months. Retrospective chart reviews were conducted to determine the level of appropriateness of the above-mentioned decisions. Results: Between June 2006 and December 2007, 200 EKGs with suspected STEMI were transmitted; 88 (44%) resulted in CLA. Compared to prior year, DTI times decreased from 145.7 to 69.9 min (P=.00001). DTI was longer during nights and weekends (87.5 vs. 51.8 min, P=.001) and the initial 6 months of the registry (86.8 vs. 66.8 min, P=.07). Nineteen (21.6%) of the patients undergoing angiography did not require revascularization, 56 (63.6%) received GPIs, and 65 patients (73.8%) underwent at least one vessel PCI, and at least one DES was used in 39 patients (60% of PCI cohort). When assessed for appropriateness, CLA was appropriate in 81.8% of the time and rendered borderline or inappropriate in 5.7% and 12.5%, respectively. GPI use was appropriate in 66% of the patients but seemed borderline or inappropriate in 28.5% and 5.4%, respectively. PCI was appropriate in 90% of the lesions treated, and borderline or inappropriate in 7.1% and 2.9%, respectively. DES use was viewed appropriate in 38.4%, and borderline or inappropriate in 51% and 10.2% of the DES deployments, respectively. Conclusions: (1) In view of expedited care, certain information required for decision-making process is either not available or ignored during primary PCI. (2) Appropriate use of resources in primary PCI needs to be better defined. (3) Measures of extracting patients' previous medical records and imaging studies along with in-lab immediate blood work and echocardiography and establishing new "time-out" protocols for STEMI patients may improve resource utilization and patient care and outcome.
KW - Bare metal stents
KW - Door to intervention time
KW - Drug eluting stents
KW - Glycoprotein IIb/IIIa ihibitors
KW - Primary PCI
KW - ST-elevation myocardial infarction
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U2 - 10.1016/j.carrev.2009.04.108
DO - 10.1016/j.carrev.2009.04.108
M3 - Article
C2 - 20347797
AN - SCOPUS:77950126214
SN - 1553-8389
VL - 11
SP - 84
EP - 90
JO - Cardiovascular Revascularization Medicine
JF - Cardiovascular Revascularization Medicine
IS - 2
ER -