NEJM: Door-to-balloon-times are reduced with Ottawan system

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If primary percutaneous coronary intervention is performed promptly, the procedure is superior to fibrinolysis in restoring flow to the infarct-related artery in patients with ST-segment elevation myocardial infarction, according to researchers at the University of Ottawa Heart Institute in Ontario.

Michel R. Le May, M.D., and colleagues developed an integrated city-wide approach in which all patients with ST-segment elevation myocardial infarction (STEMI) were referred to a specialized center for primary PCI.

They sought to determine whether there was a difference in door-to-balloon times between patients who were referred directly from the field by paramedics trained in the interpretation of electrocardiograms and patients who were referred by emergency department physicians.

They published their results in the January 17 issue of The New England Journal of Medicine.

Data from 344 consecutive patients referred for primary PCI show a 69-minute median door-to-balloon time for patients referred from the field (135) compared with a 123-minute interhospital time (209).

Door-to-balloon times of less than 90 minutes—the benchmark—were achieved in 79.7 percent of patients who were transferred from the field and in 11.9 percent of those transferred from emergency departments.