Thursday, 25 February 2016

Door to balloon time should be reduced

Door to balloon time should be reduced

Dr K K Aggarwal

Primary percutaneous coronary intervention (PPCI) with stenting, if performed in a timely manner, is associated with better outcomes than fibrinolysis. Also the time from symptom onset to PCI has not been shown to be an important determinant of outcome. The benefit from PPCI is less dependent upon the time from symptom onset than is fibrinolysis.
However the time from hospital arrival to PCI (door-to-balloon time) is an important determinant of benefit, with the best outcomes occurring when the time to PCI is 90 minutes or less.
Increasing system delay is associated with worse outcomes.

Patients who are transferred to a PCI center have better outcomes than those treated with fibrinolysis at the presenting hospital. Most of the benefit is due to a lower rate of reinfarction after PCI, which is unrelated to the time required for transfer.

Ambulance protocols that bypass non-PPCI-capable hospitals and thereby shorten system delays to PPCI are associated with improved outcomes in ST elevation myocardial infarction.

Hospitals also should adapt strategies to reduce door-to-balloon times and thereby improve outcomes in STEMI patients treated with PPCI.

PPCI should not be performed in hospitals without on-site cardiac surgery unless they meet specific criteria, including having a proven plan for rapid transport to a cardiac surgery operating room in a nearby hospital and having appropriate hemodynamic support capability for transfer.
Primary PCI should be performed within 90 minutes for patients who arrive at or who are transported by an emergency medical service to a PCI-capable hospital. Patients who arrive at or who are transported to a non-PCI-capable hospital should be transported urgently to a PCI-capable hospital if they can receive primary PCI within 120 minutes of first medical contact. 

For patients who cannot receive timely primary PCI, fibrinolytic therapy should be given. Fibrinolytic therapy should be administered within 30 minutes of first medical contact, and sooner if possible.

Each 30 mins delay leaves to 7.5% increase in mortality 
Remember  3 D
1.     Door to balloon time
2.     Early and correct diagnosis
3.     Dedicated acute MI set up in the hospitals  

MCI code of ethics: 2.4 The Patient must not be neglected: A physician is free to choose whom he will serve. He should, however, respond to any request for his assistance in an emergency. Once having undertaken a case, the physician should not neglect the patient, nor should he withdraw from the case without giving adequate notice to the patient and his family. Provisionally or fully registered medical practitioner shall not wilfully commit an act of negligence that may deprive his patient or patients from necessary medical care.

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