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Revascularization Strategies in STEMI with Multivessel Disease: Deciding on Culprit Versus Complete-Ad Hoc or Staged Acute Noncardiac Organ Failure in Acute Myocardial Infarction With Cardiogenic Shock Prevalence of Angina Among Primary Care Patients With Coronary Artery Disease Multivessel PCI Guided by FFR or Angiography for Myocardial Infarction Eruptive Calcified Nodules as a Potential Mechanism of Acute Coronary Thrombosis and Sudden Death Association of Thrombus Aspiration With Time and Mortality Among Patients With ST-Segment Elevation Myocardial Infarction: A Post Hoc Analysis of the Randomized TOTAL Trial Cardiac Shock Care Centers: JACC Review Topic of the Week Optimum Blood Pressure in Patients With Shock After Acute Myocardial Infarction and Cardiac Arrest Invasive Versus Medical Management in Patients With Prior Coronary Artery Bypass Surgery With a Non-ST Segment Elevation Acute Coronary Syndrome: A Pilot Randomized Controlled Trial Predicting Major Adverse Events in Patients With Acute Myocardial Infarction
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Original Research2014 Jul 1;114(1):24-8.

JOURNAL：Am J Cardiol. Article Link

Frequency of nonsystem delays in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention and implications for door-to-balloon time reporting (from the American Heart Association Mission: Lifeline program)

Cotoni DA1, Roe MT, Kontos MC et al. Keywords: ST-elevation myocardial infarction; primary percutaneous coronary intervention; door-to-balloon time

ABSTRACT

The percentage of patients with primary percutaneous coronary intervention (PCI) with door-to-balloon (D2B) times ≤90 minutes is used as a hospital performance measure for public reporting. Patients can be excluded from reporting for nonsystem-related delays. How exclusions impact D2B time reporting at the hospital level is unknown. The percentage of patients having nonsystem delays for primary PCI at the hospital level was calculated using data from the Acute Coronary Treatment Intervention Outcomes Network Registry-Get with the Guidelines Registry. Hospitals were categorized based on tertiles of percentage of excluded patients: low, ≤7.1%; intermediate, >7.1% to 11.2%; and high, >11.2%. From January 1, 2007, to March 31, 2011, 43,909 patients from 294 hospitals were included. The percentage of exclusions differed substantially among hospitals (0% to 68%, median 9.2% [interquartile range 5.6% to 13.5%]). Exclusion reasons included vascular access difficulty (7.6%), cardiac arrest/intubation (38%), and PCI procedural difficulties (20%). Including patients with nonsystem delays significantly increased D2B times by ≤2 minutes for each group. The effect was larger on the proportion of patients having a D2B ≤90 minutes (low 83.6% to 85%, intermediate 82.9% to 86.3%, high 82% to 87.5%, p <0.001, for all). If a criterion of having ≥90% of patients with D2B ≤90 minutes was used, excluding patients with nonsystem delays significantly increased the proportion of patients meeting this goal for each group: low, 28% to 37%; intermediate, 17.7% to 37.5%; and high, 14% to 52% (all p <0.01). In conclusion, the proportion of patients excluded from D2B reporting varies substantially among hospitals. This has a greater impact on percentage of patients with D2B time ≤90 minutes than on median D2B times.
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