Door-to-balloon time in the treatment of st segment elevation myocardial infarction in a tertiary care center in Saudi Arabia

Abstract

BACKGROUND: Atherosclerotic heart disease is still a leading cause of mortality despite improvements in cardiovascular care. Percutaneous coronary intervention (PCI) is the recommended reperfusion therapy in acute ST-elevation myocardial infarction (STEMI), and the international guideline is to achieve a door-to-balloon (D2B) time within 90 minutes of patient arrival to an emergency department (ED). OBJECTIVES: Describe interventions, data for the study period, challenges in ensuring 24/7 patient access to PCI and quality indicators. DESIGN: Retrospective observational study. SETTING: Tertiary care institution in Riyadh, Saudi Arabia. PATIENTS AND METHODS: We included all acute coronary syndrome patients from 2010-2018 who presented or were transferred to our ED from nearby non-PCI capable hospitals, and for whom a 'code heart' was activated. Electronic medical records and the patient care report from the ambulance services were accessed for data collection. MAIN OUTCOME MEASURES: D2B time, readmission and mortality rate. SAMPLE SIZE AND CHARACTERISTICS: 354 patients, mean age (standard deviation) 55.6 (12.6) years, males 84.5% (n=299). RESULTS: STEMI patients constituted 94% (n=334) of the study group; the others had non-STEMI or unstable angina. Hypertension (51%) was the most prevalent risk factor. Coronary artery stenting was the most frequent intervention (77.4%) followed by medical therapy (14.7%). The most common culprit artery was the left anterior descending (52.5%) followed by the right coronary artery (26.0%). A D2B time of within 90 minutes was achieved in over 85% of the patients in four of the years in the 278 patients who underwent PCI. The median D2B time (interquartile range) over 2010-2018 was 79 (31) minutes. CONCLUSION: Meeting the international benchmark of D2B time within 90 minutes for STEMI patients is achievable when the main stakeholders collaborate in patient-centric care. Our patient demographics represent regional rends.