Treatment delay in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction: A key process analysis of patient and program factors

Shailja V. Parikh, Joshua A. Jacobi, Edwin Chu, Tayo A Addo, John J Warner, Kathleen A. Delaney, Darren K McGuire, James A de Lemos, Joaquin E. Cigarroa, Sabina A. Murphy, Ellen C. Keeley

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background: Most hospitals that perform primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) in the United States exceed the recommended door-to-balloon time. There is heightened interest in identifying and eliminating factors that introduce delay. Methods: We performed a key process analysis of our primary PCI program, assessed the relative contribution of individual time intervals on total ischemic time, and identified predictors of delay. Results: Median times and predictors of delay within each time interval were determined for the entire STEMI cohort ("real world") and after exclusion of patients with atypical symptoms and/or presentations of STEMI that resulted in inherent delay in diagnosis and treatment ("ideal world"). Delays in therapy were symptom onset to presentation (120 minutes [interquartile range, IQR, 60-310 minutes, ideal world] and 150 minutes [IQR 60-360 minutes, real world]; predictors of delay were peripheral vascular disease, self-transportation, daytime and weekend presentation); door-to-balloon time (118.5 minutes [IQR 96-141 minutes, ideal world] and 125 minutes [IQR 100-170 minutes, real world]; predictors of delay were female sex, previous stroke, nighttime and weekend presentation, and cardiogenic shock); and symptom onset to first balloon inflation (272 minutes [IQR 187-465 minutes, ideal world] and 297 minutes [IQR 198-560 minutes, real world]; predictors of delay were peripheral vascular disease, weekend presentation, and self-transportation). Conclusions: Key process analysis of a primary PCI program identifies treatment delays unique to the hospital and the patient population it serves.

Original languageEnglish (US)
Pages (from-to)290-297
Number of pages8
JournalAmerican Heart Journal
Volume155
Issue number2
DOIs
StatePublished - Feb 2008

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Percutaneous Coronary Intervention
Peripheral Vascular Diseases
Therapeutics
Cardiogenic Shock
Economic Inflation
ST Elevation Myocardial Infarction
Stroke
Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Treatment delay in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction : A key process analysis of patient and program factors. / Parikh, Shailja V.; Jacobi, Joshua A.; Chu, Edwin; Addo, Tayo A; Warner, John J; Delaney, Kathleen A.; McGuire, Darren K; de Lemos, James A; Cigarroa, Joaquin E.; Murphy, Sabina A.; Keeley, Ellen C.

In: American Heart Journal, Vol. 155, No. 2, 02.2008, p. 290-297.

Research output: Contribution to journalArticle

Parikh, Shailja V. ; Jacobi, Joshua A. ; Chu, Edwin ; Addo, Tayo A ; Warner, John J ; Delaney, Kathleen A. ; McGuire, Darren K ; de Lemos, James A ; Cigarroa, Joaquin E. ; Murphy, Sabina A. ; Keeley, Ellen C. / Treatment delay in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction : A key process analysis of patient and program factors. In: American Heart Journal. 2008 ; Vol. 155, No. 2. pp. 290-297.
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AU - Addo, Tayo A

AU - Warner, John J

AU - Delaney, Kathleen A.

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