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Primary angioplasty
Published in K Sarat Chandra, AJ Swamy, Acute Coronary Syndromes, 2020
Srinivasan Narayanan, Ajit S Mullasari
Door-to-balloon time refers to the time from presentation to a PCI-capable centre to the first balloon inflation irrespective of stenting. PCI-related delay is the difference between the door-to-balloon time and the door-to-needle time. DIDO (Door In Door Out) is defined as the duration of time from arrival to discharge at the first STEMI referral hospital and has become a performance measure of spoke hospitals providing referral to PCI-capable hub hospitals. The 2008 ACC/AHA performance measures recommend a DIDO time of <30 minutes [11].
Unconscious bias
Published in Anna-leila Williams, Integrating Health Humanities, Social Science, and Clinical Care, 2018
Now let’s look at a recent study that used actual patients to determine treatment patterns by gender for cardiovascular disease. When a patient presents with ST-segment elevation myocardial infarction the standard of care is to treat with balloon angioplasty with the goal of revascularization. The shorter the length of time from patient presentation to insertion of the balloon (referred to as “door-to-balloon time”), the less patient morbidity and mortality. A 2013 Australian study of 735 patients presenting with ST-segment elevation myocardial infarction found, even after adjusting for covariates, women had a 13% increase in median door-to-balloon time compared to men (Dreyer et al., 2013). Other studies have found that women are less likely than men are to receive interventions to prevent and treat cardiovascular disease. Gender disparities extend to cholesterol screening and treatment, use of blood thinners during myocardial infarction, antiplatelet therapy for secondary prevention of cardiovascular disease, and implantation of cardioverter-defibrillators (Society for Women’s Health Research, 2017).
Heart disease in the elderly
Published in Clive Handler, Gerry Coghlan, Nick Brown, Management of Cardiac Problems in Primary Care, 2018
Clive Handler, Gerry Coghlan, Nick Brown
In order to salvage jeopardised myocardium as soon as possible by reperfusing it with blood, the ‘door to balloon time’ should be less than 60 minutes. The audit target in UK centres is less than 90 minutes. This service is only available in major centres in the UK.
How has COVID-19 impacted the care of patients with acute coronary syndromes?
Published in Expert Review of Cardiovascular Therapy, 2023
Arturo Cesaro, Gianantonio De Michele, Felice Gragnano, Paolo Calabrò
In this regard, the initial finding of Tam et al. on the prolongation of extra- and in-hospital times to primary PCI for patients with STEMI has been consistently confirmed by more extensive Italian case series. Secco et al. [15] evaluated patients with STEMI from three Italian high-volume centers and saw a significant increase from 2019 in door-to-balloon time (over 60 min) and symptom-to-balloon time (reaching timelines of almost 6 h), with a significantly higher percentage of late-presenting patients (>24 h) in the COVID-19 era (17.8% vs. 4.3%; p < 0.001). An increase in door-to-balloon time is associated with in-hospital death (OR 1.005, P = 0.029) [21]. Data published by De Rosa et al. [13] confirmed these delays, as increases of 39.2% and 31.5% were recorded for the arrival time to the catheter laboratory of patients with STEMI compared with symptom onset and revascularization time from first contact, respectively.
Usefulness of non-gated chest computed tomography scans in the diagnosis of acute myocardial infarction
Published in Baylor University Medical Center Proceedings, 2022
Ahmad Jabri, Laith Alhuneafat, Anas Alameh, Ahmad Al-abdouh, Mohammed Mhanna, Hani Hamade, Farhan Nasser, Adnan Yousaf, Ashish Aneja
In our cases, the patients presented to the ED with atypical chest pain and were found to have ST elevation on their electrocardiogram consistent with STEMI. Clinical findings in the first patient warranted an emergent CT aortography to rule out aortic dissection, while in the second patient emergent CT angiography of the chest was performed to rule out pulmonary embolism. Door-to-balloon time is crucial in STEMI, but additional clinical findings can make it critical to rule out noncardiac emergencies before a patient can be safely sent for a coronary angiogram. Although done for noncardiac reasons, CT scans in both patients showed myocardial perfusion defects in the coronary artery distribution pattern consistent with critical acute flow-limiting coronary artery lesions later confirmed on coronary angiogram. Our findings provide a foundation for further studies, especially in patients with cardiac arrest due to shockable rhythm and successful return of spontaneous circulation for improving triage of these high-risk patients in terms of emergent coronary angiography vs conservative management.
STEMI Equivalents and Their Incidence during EMS Transport
Published in Prehospital Emergency Care, 2022
Nicholas Palladino, Aman Shah, Jeffrey McGovern, Kevin Burns, Ryan Coughlin, Daniel Joseph, David C. Cone
A small but significant number of patients presenting with chest pain to the emergency department by EMS have ECG findings that meet criteria for STEMI equivalency. These cases do not currently meet criteria for field activation of the cardiac catheterization lab, but may ultimately require prompt catheterization. This has the potential to significantly improve door to balloon times for these patients, and may have an effect on outcome, although further research is needed to assess this. These results suggest potential benefit to education of prehospital clinicians regarding recognition of these STEMI equivalents. Further studies evaluating outcomes of these patients are needed to determine if field activations of the cardiac catheterization lab are appropriate for patients with STEMI equivalents.