1. Prof Kim Myeong Kon / R1 Park Ji Yoon
Impact of minimizing door-to-balloon times in STEMI to less than 30 min on outcome: an analysis over an 8-year period in a tertiary care center
Ulrike M. Muller • Ingo Eitel • Kristina Eckrich
Sandra Erbs • Axel Linke • Sven Mobius-Winkler
Meinhard Mende • Gerhard C. Schuler •
Meinhard Mende • Gerhard C. Schuler • Holger Thiele
Clinical Research in Cardiology, 1 Oct 2010
Prof Kim Myeong Kon / R1 Park Ji Yoon

2. INTRODUCTION Rapid and effective reperfusion in STEMI
 prevent myocardial cell death & improve clinical outcomes
Current guideline - door-to-balloon time (DBT) < 60 min
30 min of reperfusion delay
– increase relative risk of 1-year mortality by 7.5%
Purpose of this study
analyse revascularization times and outcomes in STEMI patients
in a tertiary care centre over 5-year period (2004–2008)
- identify hospital strategies for a marked DBT reduction

3. METHOD Prospective observational cohort study
Tertiary care center providing 24 h interventional strategy
1) Door-to-balloon time
- time interval between hospital arrival and reperfusion
2) Pain-to-balloon time
- time interval between symptom-onset to PCI
3) First-hospital-contact to-balloon time
- time delay in transferring hospital plus DBT

4. STEMI protocol
1. DBT maximum 30 min 2. Education for emergency physicians, paramedics, intensive care physicians 3. Telemetric transmission of EKG to coronary care unit 4. Emergency physicians to alert intensive care physicians of impending arrival of STEMI patient using always same telephone number 5. Activation of cardiac interventional team, while patient being transferred to hospital 6. Introduction of signal colored STEMI-triage protocol 7. Direct cath lab transfer bypassing emergency department 8. Weekly quality assurance meetings to provide prompt data feedback

5. Study population

6. Baseline characteristics were similar in three Pt groups
RESULT
Baseline characteristics were similar in three Pt groups

7. Angiographic and procedural characteristics were similar in three Pt groups

9. Trend for door-to-balloon time & pain-to-balloon time
Figure 2.
Trend for door-to-balloon time & pain-to-balloon time

10. Influence of DBT & Impact of DBT after implementation of protocol
Figure 3-a.
Influence of DBT & Impact of DBT after implementation of protocol

11. Influence of PBT & Impact of PBT after implementation of protocol
Figure 3-b.
Influence of PBT & Impact of PBT
after implementation of protocol

12. Figure 4. Impact of DBT & PBT on 6-month mortality

13. Figure 4. Impact of DBT & PBT on MACE

16. CONCLUSION
The implementation of an optimized, structured STEMI protocol significantly reduces DBT and helps PCI centers to get with the guidelines.
Those improvements have contributed to a decline
in mortality and morbidity.
Rather than accepting a 60 min DBT benchmark for primary PCI,
authors suggest an ‘‘as soon as possible’’ standard
for patients undergoing primary PCI.