A Citywide Protocol for Primary PCI in ST-Segment Elevation Myocardial Infarction

To minimize door-to-balloon times, Ottawa developed a program in which patients with ST-elevation myocardial infarction were taken directly from the field to a cardiac care center for primary coronary angioplasty. The median door-to-balloon time (69 minutes) was approximately half that of patients who were transferred from emergency departments (123 minutes). Respective in-hospital mortality rates were 3.0% and 5.7% (P=0.30). Ottawa developed a program in which patients with ST-elevation myocardial infarction were taken directly from the field to a cardiac care center for primary coronary angioplasty. The median door-to-balloon time (69 minutes) was approximately half that of patients who were transferred from emergency departments (123 minutes). Survival of patients presenting with ST-segment elevation myocardial infarction is enhanced by rapid, complete, and sustained reperfusion of the infarct-related artery. 1 – 3 Delays in either door-to-needle 1 or door-to-balloon 4 – 7 times are associated with increased mortality. In patients who are treated with primary percutaneous coronary intervention (PCI), each 30 minutes of delay increases the relative risk of 1-year mortality by 7.5%. 6 It has been recommended that efforts be made to shorten door-to-balloon times for all patients because time-to-balloon strongly correlates with mortality regardless of the baseline risk of mortality. 7 PCI ensures more complete and sustained restoration of flow to the infarct-related . . .