Academic Journal
Main Category: Cardiovascular / Cardiology
Also Included In: Heart Disease
Article Date: 30 Nov 2011 - 8:00 PST
email to a friend 
printer friendly 
opinions 
According to an investigation in the Nov. 28 issue of Archives of Internal Medicine, one of the JAMA/Archives journals, the estimated time for patients in need of transfer to another hospital for percutaneous coronary intervention (PCI; procedures such as stent placement of balloon angioplasty used to open narrow coronary arteries) seldom meets the recommended guidelines of 30 minutes or less.
The researchers explain:
"Delays in treatment time are commonplace for patients with ST-segment elevation acute myocardial infarction (STEMI) who must be transferred to another hospital for percutaneous coronary intervention. Experts have recommended that door-in to door-out (DIDO) time (i.e., the time from arrival at the first hospital to transfer from that hospital to the percutaneous coronary intervention hospital) should not exceed 30 minutes."
Jeph Herrin, Ph.D., of Yale University School of Medicine, New Haven, Conn., and his team, set out to analyze DIDO times for individuals who arrived at an emergency department with STEMI and who required transfer to another hospital for PCI. The team analyzed data on all individuals' hospitals reported with five or more suitable transfer patients between January 1, and December 31, 2009.
According to results from the study, out of the 13,776 individuals from 1,034 hospital included in the examination, 9.7% (1,343) patients DIDO time was within the recommended 30 minutes, while for 4,267 patients (31%) DIDO time exceeded 90 minutes. After the team adjusted for hospital and patient characteristics they found: Women had a mean (average) estimated time 8.9 minutes longer than men African Americans estimated time was 9.1 minutes longer compared to white patients Individuals aged between 18-35 years had an estimated time considerably longer than all patients apart from those over the age of 75, with a time 18.3 minutes longer relative to those aged 46-55 yearsThe researchers conclude:
"Among patients presenting to emergency departments and requiring transfer to another facility for percutaneous coronary intervention, the DIDO time rarely met the recommended 30 minutes. DIDO time may be a key component of treatment delays in patients with STEMI who are transferred for PCI; improvement efforts should focus on understanding and reducing this delay."
Furthermore, in a study published Online First, Eric A. Secemsky, M.D., of the University of California, San Francisco, and his team set out to analyze if developing a 24-hour cardiac catheterization laboratory (CCL) was connected with enhanced transfer times among individuals with STEMI presenting at a public hospital previously reliant on transferring individuals for percutaneous coronary intervention.
The team enrolled patients with a clinical diagnosis of STEMI between April 2005 and October 2008, successful transfer for angiography and available data for all time intervals. They discovered that among transfer patients, median (midpoint) times were 184 minutes for door-to-catheterization (DTC) and 200 minutes for door-to-balloon (DTB), with no patients transferred in under 90 minutes. Among individuals treated after the 24-hour PCI facility was created median times for DTC reduced to 50 minutes, and median times for DTB decreased to 84 minutes, with 65% of individuals transferred in under 90 minutes.
The researchers conclude:
"Creation of a CCL successfully improved median DTB times to less than 90 minutes, and currently, nearly 90 percent of patients with STEMI are revascularized in less than 90 minutes."
In an article published Online First, Archives editor Rita F. Redberg, M.D., M.Sc., of the University of California, San Francisco, states: "Primary PCI [pPCI] is resource intensive and therefore not widely available. Of the nearly 5,000 acute care hospitals in the United States, less than one-fourth have PCI capability and even less can provide 24-hours-a-day, 7-days-per-week (24/7) PCI.
Despite years of hard work and noble efforts by many individuals and professional organizations...to enable hospitals to either provide pPCI or reduce door-in to door-out (DIDO) time in transferring to a facility that does, results have been disappointing. After years of well-intentioned arduous efforts to decrease DIDO time, it is time to consider other strategies.
Dr. Redberg concludes:
"The reports by Herrin et al and Want et al show us that DIDO time remains much slower than benchmarks. For low- and intermediate-risk patients, there is no mortality advantage to pPCI over thrombolytic therapy...It is time to reconsider transferring patients with STEMI for pPCI. Timely reperfusion by thrombolytics, not late pPCI via transfer, will save lives."
Written by Grace Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
Arch Intern Med. November 28, 2011. doi:10.1001/archinternmed.2011.566.
Please use one of the following formats to cite this article in your essay, paper or report:MLA
9 Dec. 2011.
Please note: If no author information is provided, the source is cited instead.
Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.
If you write about specific medications or operations, please do not name health care professionals by name.
All opinions are moderated before being included (to stop spam)
Contact Our News Editors
For any corrections of factual information, or to contact the editors please use our feedback form.
Please send any medical news or health news press releases to:
Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.
