AHJ: Direct emergency admission to cath lab reduces time to intervention

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Direct admission of patients with suspected STEMI from ambulance to the cath lab significantly reduces time to treatment in primary PCI, allowing the 90-minute door-to-balloon time target to be reliably achieved, according to a study in the June issue of the American Heart Journal.

Michael F. Dorsch, MD, PhD, and colleagues from the department of cardiology at Leeds General Infirmary in Leeds, England, performed a prospective evaluation of a new system of paramedic electrocardiogram (ECG) diagnosis of STEMI and subsequent direct ambulance admission to the cardiac catheterization laboratory for primary PCI.

The researchers recorded door-to-balloon and call-to-balloon times for all patients, and compared direct admissions with admissions via the emergency room of the interventional center and of two referring hospitals. The authors wrote that all times were quoted as medians.

The investigators examined 577 patients (70 percent male with average age of 63 years), who underwent primary PCI between April 2005 and May 2007.

After February 2006, Dorsch and colleagues reported that 172 (44 percent) of 387 patients were admitted directly from the ambulance to the cath lab.

The investigators found that directly admitted patients had significantly reduced door-to-balloon (58 vs. 105 minutes) and call-to-balloon times (105 vs. 143 minutes). The 90-minute target for door-to-balloon time was achieved in 94 percent of direct admissions, compared to 29 percent of patients referred from the emergency room, according to the authors.

"Prehospital paramedic ECG diagnosis of STEMI and subsequent direct ambulance admission to the cardiac catheterization laboratory dramatically reduces door-to-balloon times in primary PCI, enabling almost all patients to be treated within the 90-minute target," Dorsch and colleagues wrote. "We believe this approach should be a key element of any contemporary primary PCI service."