Factors associated with door-in to door-out delays among ST-segment elevation myocardial infarction (STEMI) patients transferred for primary percutaneous coronary intervention: a population-based cohort study in Ontario, Canada

• Published in: BMC cardiovascular disorders 2018-10, Vol.18 (1), p.204-204, Article 204
• Main Authors: Shi, Oumin, Khan, Anam M, Rezai, Mohammad R, Jackevicius, Cynthia A, Cox, Jafna, Atzema, Clare L, Ko, Dennis T, Stukel, Thérèse A, Lambert, Laurie J, Natarajan, Madhu K, Zheng, Zhi-Jie, Tu, Jack V
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Factors; Aged; Ambulatory care; Angioplasty; Balloon treatment; Benchmarking; Catheterization; Cohort analysis; Databases, Factual; Door-in to door-out (DIDO); EKG; Electrocardiography; Emergency Medical Services; Emergency services; Female; Heart attacks; Hospitals; Humans; Male; Middle Aged; Mortality; Myocardial infarction; Ontario; Patient Transfer; Patients; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - mortality; Population; Population studies; Population-based studies; Pre-hospital electrocardiogram (ECG); Primary percutaneous coronary intervention (PCI); Privacy; Quality Improvement; Quality Indicators, Health Care; Retrospective Studies; Risk Factors; ST Elevation Myocardial Infarction - diagnostic imaging; ST Elevation Myocardial Infarction - mortality; ST Elevation Myocardial Infarction - surgery; ST-segment elevation myocardial infarction (STEMI); Studies; Time Factors; Time-to-Treatment; Treatment Outcome; Young Adult
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-018-0940-z

Compared to ST-segment elevation myocardial infarction (STEMI) patients who present at centres with catheterization facilities, those transferred for primary percutaneous coronary intervention (PCI) have substantially longer door-in to door-out (DIDO) times, where DIDO is defined as the time interval from arrival at a non-PCI hospital, to transfer to a PCI hospital. We aimed to identify potentially modifiable factors to improve DIDO times in Ontario, Canada and to assess the impact of DIDO times on 30-day mortality. A population-based, retrospective cohort study of 966 STEMI patients transferred for primary PCI in Ontario in 2012 was conducted. Baseline factors were examined across timely DIDO status. Multivariate logistic regression was used to examine independent predictors of timely DIDO as well as the association between DIDO times and 30-day mortality. The median DIDO time was 55 min, with 20.1% of patients achieving the recommended DIDO benchmark of ≤30 min. Age (OR 0.30, 95% CI: 0.16-0.56), symptom-to-first medical contact (FMC) time (OR 0.60, 95% CI: 0.39-0.90; OR 0.53, 95% CI:0.35-0.81) and emergency medical services transport with a pre-hospital electrocardiogram (ECG) (OR 2.63, 95% CI:1.59-4.35) were the strongest predictors of timely DIDO. Patients with timely ECG were more likely to have recommended DIDO times (33.0% vs 12.3%; P