Hong Kong Med J 2010;16:347–53 | Number 5, October 2010
Primary percutaneous coronary intervention for ST elevation myocardial infarction: performance with focus on timeliness of treatment
Gary SH Cheung, KL Tsui, CC Lau, HL Chan, CH Chau, KL Wu, CY Cheung, MC Choi, TS Tse, KK Chan, SK Li
Department of Medicine, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong
OBJECTIVE. To review primary percutaneous coronary interventions performed for patients with ST elevation myocardial infarction with a focus on door-to-treatment time, especially after introduction of a new management programme in November 2003.
DESIGN. Retrospective study.
SETTING. Regional hospital, Hong Kong.
PATIENTS. All patients with ST elevation myocardial infarction who underwent primary percutaneous coronary intervention in our hospital from January 2002 to December 2007.
RESULTS. In all, 209 patients with ST elevation myocardial infarction had primary percutaneous coronary interventions between January 2002 and December 2007; 140 of them were admitted within office hours, 125 of whom came directly from Accident and Emergency Department. The mean door-to-balloon time of these patients was 115 minutes, and in 41% the time was less than 90 minutes (as recommended by the American College of Cardiology/American Heart Association guidelines). Since introduction of the new programme, the mean door-to-balloon time has diminished significantly, from 146 to 116 minutes (P=0.047). Delay in diagnosis (28%) and Cardiac Catheterization Laboratory being occupied (20%) were the two most common reasons for prolonged door-to-balloon times.
CONCLUSION. We achieved satisfactory performance in our primary percutaneous coronary intervention programme, providing timely reperfusion therapy for patients with ST elevation myocardial infarction. A well-organised and systematic clinical pathway is a prerequisite for a centre that provides a timely and effective primary percutaneous coronary intervention service for patients with ST elevation myocardial infarction. Better public education and greater awareness on the part of medical service providers are needed, so as to facilitate urgent revascularisation and improve outcomes in patients with ST elevation myocardial infarction.
Key words: Angioplasty, transluminal, percutaneous coronary; Myocardial infarction; Myocardial reperfusion; Thrombolytic therapy; Time factors
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