Predictors of delay in door-to-balloon time in STEMI patients, treated in centers capable in primary PCI

The Government of Catalonia (Spain) provided funding for this research grant: PERIS 2019-2021

European Society of Cardiology (ESC) clinical guidelines recommend a diagnosis-to-balloon time < 60 minutes in acute myocardial infarction with ST elevation (STEMI) when the patient directly arrives to emergency room (ER) of a center with primary angioplasty (PCI) capacity. Hospitals that implement a greater number of improvement strategies tend to have a shorter door-to-balloon time (D2B).

to describe the attendance times and to evaluate the causes of delay in attendance in STEMI patients.

This is an observational retrospective study, including all consecutive ≥18 years STEMI patients attended in the ER of a terciary Hospital capable in primary PCI from January 2013 to December 2016. Patients who were not activated as STEMI code from the hospital ER and without coronariography were excluded. Sociodemographic and clinical variables were collected for all the patients. ER management is based on the Plan-Do-Study-Act methodology, for this reason other organizational variables have been considered such as brief educational interventions aimed at emergency nurses. All the patients were stratified into two groups, according to their door-to-balloon time (< 70 minutes or equal/more).

Overall 327 patients were included. Mortality was 11,6% and 88 minutes between arrival at the ER to balloon time. The delayed treatment group was older (p = 0.005), with more female (p = 0.060), usually admitted in not working hours (p = 0.001), with more atypical ECG STEMI signs or symptoms (p = 0.058) and (p = 0.087). They had also a  longer hospital stay (p = 0.041). Predictors of shorter D2B time were: typical STEMI ECG signs and brief education sessions to nurses for identification of a STEMI.

There are delays in the treatment of STEMI, especially in specific groups of patients with atypical clinical presentations. Brief educational session aimed at emergency nurses correlate with less delay. This shows that continuing education to emergency nurses along with other organizational improvement strategies can contribute to increasing the quality of care in the STEMI.