Author/Authors :
Salarifar, Mojtaba Tehran University of Medical Sciences, Tehran , Askari, Javad Tehran University of Medical Sciences, Tehran , Saadat, Mohammad Tehran University of Medical Sciences, Tehran , Geraiely, Babak Tehran University of Medical Sciences, Tehran , Omid, Negar Tehran University of Medical Sciences, Tehran , Poorhosseini, Hamidreza Tehran University of Medical Sciences, Tehran , Amirzadegan, Alireza Tehran University of Medical Sciences, Tehran , Hajzeinali, Alimohammad Tehran University of Medical Sciences, Tehran , Alidoosti, Mohammad Tehran University of Medical Sciences, Tehran , Aghajani, Hassan Tehran University of Medical Sciences, Tehran , Nozari, Younes Tehran University of Medical Sciences, Tehran , Nematipoor, Ebrahim Tehran University of Medical Sciences, Tehran
Abstract :
Background: Performing primary percutaneous coronary intervention (PPCI) in a timely fashion is a crucial part of the
management of ST-elevation myocardial infarction (STEMI). We aimed to evaluate the contributing factors to and the etiologies
of a prolonged door-to-device (D2D) time.
Methods: In 2016, the D2D time was measured in all patients who were treated with PPCI at Tehran Hear Center. The major
causes of a prolonged D2D time (>90 min) were determined. The second phase was then started in 2017 by focusing on the
determined causes, and direct feedback was given to anyone having contributed to the delayed D2D time. The D2D time was
compared between these 2 years.
Results: The mean age of the patients was 59.54±11.82 years, and 82.2% of them were men. The median D2D time decreased
from 55 minutes (IQR25-75%: 40–82) in 2016 to 46 minutes (IQR25-75%: 34–70) in 2017 (P<0.001). In the first year, 79.8% of
the patients had a D2D time of below 90 minutes; the figure rose to 84.1% of the patients in the second year (P=0.017). The
first cause of a prolonged D2D time was missed ST-elevation in the first electrocardiogram by physician or nurse (8.4% of the
cases). Along with a declining rate of missed STE to 6.7%, the median D2D time in the missed patients also decreased from
205 minutes to 177 minutes (P=0.011). The rate of ambulance arrival increased from 10.2% to 20.7% of the cases, and the
median D2D time also declined from 45 (IQR25-75%: 34–55) to 34 (IQR25-75%: 25–55) in these patients (P<0.001).
Conclusion: Even in the setting of a 24/7 on-site interventionist in the hospital, the dispatch system and prehospital
electrocardiograms, along with regular assessment and feedback, may improve the D2D time.
