San Diego -- An on-site, seven-day, 24-hour (24x7) interventional cardiologist eliminates longer door-to-balloon times associated with off-hours presentation and reduces mortality in patients who present off hours, according to a study presented today at the Society for Cardiovascular Angiography and Interventions (SCAI) 33rd annual scientific sessions.
While round-the-clock primary PCI for STEMI patients is not available at most medical centers, admission during off hours also is associated with higher door-to-balloon times and mortality. Researchers from Aurora St. Luke’s Medical Center in Milwaukee examined the effect of a 24/7 in-hospital cardiac cath lab program on door-to-balloon times in patients presenting with STEMI during off versus regular hours.
During the study period of April 1, 2004, to June 30, 2009, the investigators assessed 611 consecutive STEMI patients (median age 60 years; female 30.3 percent; 59.4 percent regular hours and 40.6 percent off hours). Door-to-balloon times were compared during regular hours (weekdays 7:30 a.m.-7:30 p.m.) and off hours (weekends, holidays and 7:30 p.m.-7:30 a.m. weeknights).
“This type of program does require a systems change,” said lead author M. Fuad Jan, MD, a cardiovascular disease fellow at Aurora Sinai and Saint Luke's Medical Centers in Milwaukee. “We have created a culture that makes it work.”
According to the researchers, the median door-to-balloon times following implementation of the 24/7 STEMI protocol was 55 minutes (interquartile range 43-71 minutes) with 89 percent of patients reperfused within the less than 90-minute goal recommended by the American College of Cardiology guidelines. They found no difference between door-to-balloon times during regular versus off hours.
In the five years since the protocol’s inception, a significantly greater number of STEMI patients (89 percent) were revascularized within the guideline-suggested 90 minutes during both on and off hours. Also, they reported that in-hospital mortality was similar in the two groups (on hours=16.3 percent versus off hours=15.7 percent).
A 24/7 program requires commitment from both physicians and the hospital, Jan said, but the benefits are clear. Not only do patients receive faster care, but the hospital has seen a substantial increase in the number of MI patients transferred from neighboring hospitals that do not have round-the-clock cath lab coverage.