Objective: Infarct angioplasty is now established as the ‘gold standard’ for best practice in the management of S-T Segment Myocardial Infarctions (STEMI). Key performance indicators are a door to balloon (D2B) inflation time <90mins with a total downtime <12hrs from onset of symptoms. We postulate that direct STEMI admissions to a catheter laboratory can facilitate rapid and effective intervention.
Method: A direct admission system for patients with cardiac problems was established in July 2005 to bypass Emergency Departments and duplicated assessments. In conjunction, several strategies were implemented focusing on collaboration of community, practitioners, Cardiologists, and Cardiac Services. Patients requiring emergency angiography were fast-tracked to Cath Lab through a Rapid Assessment Unit. Admission data was captured through a clinical database from July 2005 - July 2010.
Results: Of 78 direct admissions with STEMI, 96.15% received reperfusion in under 90 minutes of arrival. The average D2B time was 40.76 minutes.
Distribution of D2B times indicated the following;
-58.97% of patients received reperfusion in less than 45 minutes.
-76.91% of patients received reperfusion in less than 60 minutes.
-96.15% received reperfusion within guideline-recommended D2B of < 90 minutes.
-3.8% of patients did not receive reperfusion in less than 90 minutes.
Conclusion: The service has demonstrated an exceptionally high rate of compliance with best practice standards, through a strategy of developing strong links with emergency services, local medical practitioners, and rapid assessment through direct cardiac admissions.