Nawaz, Yassir, MD

Patel, Nainesh C, MD

Qureshi, Ataul, MD

Rivera, Orlando E, RN

Subrayappa, Navin K, MD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of MedicineThe Effect of Shortening Door to Balloon Time(<90 >Minutes) in STEMI Patients TransferredFrom Outside HospitalsAtaul Qureshi MDLehigh Valley Health Network, Ataul.Qureshi@lvhn.orgYassir Nawaz MDLehigh Valley Health Network, Yassir.Nawaz@lvhn.orgNavin K. Subrayappa MDLehigh Valley Health Network, Navin_K.Subrayappa@lvhn.orgOrlando E. Rivera RNLehigh Valley Health Network, Orlando_E.Rivera@lvhn.orgNainesh C. Patel MDLehigh Valley Health Network, nainesh_c.patel@lvhn.orgFollow this and additional works at: http://scholarlyworks.lvhn.org/medicinePart of the Cardiology Commons, Medical Sciences Commons, and the Statistics and ProbabilityCommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtQureshi, A., Nawaz, K., Subrayappa, N., Rivera, O., & Patel, N. (2014, June 23-27). The effect of Ssortening door to balloon time (Minutes)in STEMI patients transferred from outside hospitals. Poster presented at: The 10th annual Complex Cardiovascular CatheterTherapeutics: Advanced Endovascular and Coronary Intervention Global Summit , Orlando, FL.Lehigh Valley Health Network, Allentown, PennsylvaniaYassir Nawaz MD, Ataul Qureshi MD, Navin Kumar Subrayappa MD, Orlando Rivera BSN, Bruce Feldman MD, Nainesh Patel MDIntroduction•		Coronary artery disease is the leading cause of death in the United States. ST-Elevation Myocardial Infarction (STEMI) is it’s extreme manifestation. Significant research has been devoted to reduce the mortality and morbidity in this condition. •		In STEMI patients early reperfusion is an important consideration in improving outcomes. •		The 2007 ACC/AHA guidelines sets a goal of reperfusion of the infarct related artery to within 90 minutes of presentation.  This benchmark was shown as a cutoff time beyond which significantly worsened outcomes could be expected and became known as “door to balloon time” . The 2013 ACC/AHA guidelines now recommends a FMC-device time of ≤ 90 mins.•		However there are fewer studies  studying the effect of further reducing door to balloon time (D2B) on in-hospital mortality and length of stay. Rapid Door-to-Balloon Time (≤ 30 minutes) in the Treatment of Acute ST-Elevation Myocardial Infarction (STEMI) is Associated With Reduced Length of Hospital Stay and Improved Clinical Outcomes© 2014 Lehigh Valley Health NetworkObjective•		Our study examined the effect of very short D2B time ≤ 30 min on length of hospital stay and in-hospital mortality. The hypothesis is that further reducing the D2B time to ≤ 30 minutes will significantly reduce in-hospital mortality and length of stay.Methods•		We examined 356 consecutive patients who presented to Lehigh Valley Health Network, an 880 bed academic community hospital in Allentown, PA from 2008-2011. The study included patients who presented  with acute STEMI and underwent percutaneous coronary intervention. •		Of these 356 patients 40 (11%) had a D2B of ≤ 30 min (referred to as the “earlier” cohort) and 316 (89%) had a D2B of > 30 min ( “later” cohort). •		28 patients were excluded from the length of stay calculation in the later cohort and 1 from the earlier cohort. Reasons for exclusion included  death, presence of cardiogenic shock, transfer to other hospitals for advanced heart failure therapies, ventricular fibrillation requiring  hypothermia cooling and preexisting multiorgan failure. •		D2B time of the cohorts is presented below. (Table1)•		Demographic data such as age and coronary artery risk factors such as, male gender, hypertension, tobacco use, history of coronary artery disease, diabetes, prior CVA and age were similar between the two groups ( Table2). (p-values represent differences between groups after exclusions).Results•		Overall Mean time to hospital discharge in the earlier group was 3.28 days which lengthened to 4.61 days in the latter group (p<0.001). Without exclusions the mean time to hospital discharge in the later cohort was 4.96 days. (Graph	1)•		Ten deaths were noted in the later group. No deaths were seen in the earlier group (p=0.001). •		In the later group, 25 patients had cardiogenic shock compared to none in the earlier group.•		Left Ventricular ejection fraction trended towards significance being lower in the later group (50.7% vs 45.7%, p=0.06). The prevalence of anterior myocardial infarction was higher in the later group (p<0.001). (Table	3)•		Even after excluding patients in cardiogenic shock a clear difference is still noted in time to hospital discharge as it relates to door to balloon time. Conclusions•		Reducing door to balloon time is associated with reduced length of hospital stay.•		Short door to balloon times were associated with fewer mortalities and episodes of cardiogenic shock.•		A hypothesis for this difference could include salvage of more myocardial muscle by faster revascularization, as demonstrated by a trend towards higher left ventricular ejection fraction in those revascularized early. •		Confounding factors include increased prevalence of anterior myocardial infarction in later cohort. •		Future direction involves quantifying scar burden by follow up echocardiogram or MRI as well as examining outcomes at 30 days and 1 year. TABLE 1. Door to Balloon Time  Earlier (n=39) Later (n=288)Door to Balloon (min) 24.9 63   TABLE 2. Demographic Data and Risk Factors  Earlier (n=39) Later (n=288) p ValueAverage Age (yrs) 61.3 ± 10.0     61.9 ± 13.0 0.711Male Gender 71.7% 74.3% 0.747Hypertension 71.8% 63.2% 0.077Tobacco Use 25.6% 34.0% 0.276Prior CAD 23.1% 25.3% 0.757Diabetes 25.6% 21.2% 0.553Dyslipidemia 76.9% 51.7% 0.001Prior CVA 2.6% 4.2% 0.572   TABLE 3. Procedure, Infarct Location and EF% Data  Earlier (n=39) Later (n=288) p ValueLeft ventricular EF% 50.7 47.7 0.061Drug Eluting Stent 53.8% 61.8% 0.358Anterior Infarct by EKG 20.5% 46.2% 0.001   Disclosures:   None.Graph 1Length of Stay3.284.6100.511.522.533.544.55Earlier (n=39) Later (n=288)P=0.001Days

The Effect of Shortening Door to Balloon Time (\u3c90 Minutes) in STEMI Patients Transferred From Outside Hospitals

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The Effect of Shortening Door to Balloon Time (\u3c90 Minutes) in STEMI Patients Transferred From Outside Hospitals

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