Background Guidelines recommend a door-to-balloon time (D2B)<90 min for patients with ST-segment elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PPCI). Little is currently reported about systems of care to achieve this D2B performance in China. The objective of this study was to compare median D2B time and the percentage of patients treated within 90 min in Beijing Anzhen Hospital during two different periods.
Methods STEMI protocol to shorten D2B time in Beijing Anzhen Hospital in recent 2 years included activation of the cardiac catheterisation laboratory by the cardiologist in emergency department; all members of the intervention team use cell phones; catheterisation laboratory staff arrival within 20–30 min of activation; enhancing close integration of ambulance networks and hospital such as advance notification and pre-hospital ECG by ambulance crews; and bypassing the emergency room. Data were prospectively collected from STEMI patients admitted within 12 h of symptom onset and underwent PPCI during two different periods: in 2006 (n=138) and in 2009 (n=156). D2B times and its components were compared between two groups.
Results The median D2B time decreased from 120 min IQR=88–150 min) in 2006 to 80 min (IQR=60–105) in 2009 (p<0.0001). More precisely, subinterval time periods for the median door-to-ECG time decreased from 5 min in 2006 to 3 min in 2009 (p<0.0001), the median door-to-sign the operation approval time decreased from 35 min in 2006 to 15 min in 2009 (p<0.0001), the median sign-to-puncture time decreased from 80 min to 60 min (p<0.0001), and the median puncture-to-balloon decreased from 25 min to 20 min (p<0.0001). Importantly, the proportion of patients with D2B times<90 min increased from 21.4% in 2006 to 65.7% in 2009 (p<0.0001).
Conclusions D2B time decreased significantly from 2006 to 2009 in Beijing Anzhen Hospital. Accordingly, the percentage of patients treated within 90 min has dramatically increased from 2006 to 2009. Our experience demonstrates the effectiveness of process changes targeting timeliness of PPCI.