Time Delays in Performing Primary Angioplasty in Patients Transferred with Acute Myocardial Infarction: a Health-Care Issue

pp. 88-95

Abstract

Background

It has been exhaustively proved that in patients with acute myocardial infarction (AMI) time to reperfusion is closely

related to short and long-term outcomes; therefore, time between onset of symptoms and coronary reperfusion is extremely important. This time interval comprises two periods: “patient time” and “health-care time”. In terms of primary angioplasty, analysis of both time intervals is a necessary step to achieve a reduction in delay to reperfusion.

Objective

The aim of this study was to analyze the time intervals in each stage of the process hospital transfer-angioplasty (either primary or rescue angioplasty) in patients with ST-segment elevation acute myocardial infarction (STEMI) transferred from a hospital with no angioplasty facilities to a tertiary medical center in the city of Buenos Aires, as a first step for implementing a time optimized program.

Material and Methods

We conducted a prospective and observational study of patients transferred to the Hospital General de Agudos “Dr. Cosme Argerich” for percutaneous coronary intervention (PCI) due to STEMI. Time intervals from symptoms onset until coronary reperfusion were analyzed: “patient time”, defined as the time interval from onset of symptoms until arrival at the referral center, and “health-care time”, defined as the time interval from arrival at the referral center to balloon inflation.

Results

The study included 313 patients; 225 (72%) underwent primary percutaneous coronary intervention (PCI) and rescue angioplasty (RPCI) was performed in 88 patients (28%). Median (quartile) time intervals in PCI patients were as follows: patient time: 90’ (40-240); arrival at referral center- call to the catheterization laboratory team on duty (CLTOD) time: 80’ (35-150); call to CLTOD-arrival at the cath lab time: 75’ (55-100); arrival at the cath lab-balloon time: 35’ (23-52); health-care time: 220’ (142-290); ambulance transport time: 31’ (26-40). Median (quartile) time intervals in RPCI patients were as follows: patient time: 90’ (30-120); arrival at referral center-call to CLTOD time: 180’ (120-245); call to CLTOD-arrival at the cath lab time: 85’ (60-115); arrival at the cath lab-balloon time: 40’ (26- 61), health-care time: 297’ (230-395); ambulance transport time: 34’ (28-44).

Conclusions

“Patient time” interval accounts for approximately one third of the total time. “Health-care time” is the main cause related to time delay in starting the procedure. Reduction in time delays might only be achieved by implementing a program focused on multifactorial and interdisciplinary strategies.