Impact of a 24/7 on-site percutaneous coronary intervention team strategy on door-to-wire time.

Abstract

Background: Current guidelines recommend that the door-to-wire (D2W) time should be <90 min in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). This study evaluated the effect of a 24/7 on-site PCI team strategy on the D2W time.

Methods: In this single-centre, retrospective study, patients with STEMI undergoing primary PCI within 1 year before (control group, n=143) and 1 year after (intervention group, n=96) implementing a 24/7 on-site PCI team strategy were enrolled. This strategy required that the PCI team was always available in hospital to minimise the time required to make the catheterisation laboratory ready for PCI. The primary endpoint was the D2W time, and the secondary endpoints were the rate of delayed PCI (D2W time ≥90 min) and the on-site time of the PCI team members. Multivariate analysis was conducted to determine the independent predictors of delayed PCI in the intervention group.

Results: The D2W time was shorter (52 vs 97 min, p<0.001), the rate of delayed PCI was lower (19.8% vs 55.2%, p<0.001), but the on-site time of the PCI team members (35 040 vs 9960 hours) was longer in the intervention group than in the control group. Time-to-obtain electrocardiogram >10 min (p=0.027) and time-to-make STEMI diagnosis >9 min (p=0.001) were independent predictors of delayed PCI after implementing the strategy.

Conclusions: Implementing a 24/7 on-site PCI team strategy was associated with reductions in the D2W time and the rate of delayed PCI but an increase in the on-site time of the PCI team members.