Timeframe Factors of Door-to-Device Time During Pandemic Situation in a Tertiary Cardiovascular Centre in Indonesia
Keywords:
Keywords: acute ST-elevation myocardial infraction; Coronavirus disease 2019 pandemic; Door-to-device time; Primary percutaneous coronary intervention
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic has greatly affected every aspect of life, especially in the field of cardiovascular services. This creates many challenges in the treatment of highly time-sensitive and potentially lethal conditions such as ST-elevation acute myocardial infarction (STEMI). STEMI patients at high risk for COVID-19 are recommended to be evaluated with additional testing for COVID-19 and possibly require respiratory support, all of which can delay Door-to-device time (DTDT).
Objective: In this study, we sought to determine the DTDT for primary percutaneous coronary intervention (PCI) in acute STEMI, the various timeframes influencing the DTDT, and which time factor has the most significant correlation to DTDT in the COVID-19 pandemic era.
Methods: A longitudinal retrospective study was conducted at the largest tertiary referral hospital in Indonesia from March 2020 to February 2021. The following timeframes were measured during the study: Door-to-Diagnosis Time [Δt1], Diagnosis-to-Activation Time [Δt2], Informed Consent Time [Δt3], Preparation at Emergency Room (ER) Time [Δt4], Preparation at Catheterization Laboratory Time [Δt6], and PCI Initiation-to-Balloon Time [Δt7]. Spearman’s correlation (ρ) was used to ascertain the correlation among time factors.
Results: 238 patients met the inclusion criteria of this study. The observed DTDT was 110 [47 – 437] minutes. Of the variables, DTDT had a strong positive correlation with preparation at the ER time (median 28,0 (1 – 344) minutes; r = 0.702; p-value < 0.0001).
Conclusion: This study sheds light on preparation at the ER time as a significant influencing factor for Door-to-device time in the COVID-19 pandemic era.
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References
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18. Rathore SS, Curtis JP, Chen J, et al. Association of Door-to-device time and mortality in patients admitted to hospital with ST elevation myocardial infarction: national cohort study. BMJ (Clin Res Ed). 2009;338:b1807. https://doi.org/10.1136/bmj.b1807.
19. Dhungel S, Rabi M, Chandramani A, Arun M, Rajib R, Ranjit S, Himanshu N, Binaya R, Dharmanath Y. Door-to-device time and the determining factors in a tertiary cardiac center in Nepal. Indian Heart Journal. 2018;70:S309–S312. https://doi.org/10.1016/j.ihj.2018.07.011
20. Lubovich A, Hamood H, Behar S, Rosenchein U. Bypassing the emergency room to reduce Door-to-device time and improve outcomes of patients with ST elevation myocardial infarction: the Acute Coronary Syndrome Israeli Survey experience. Isr Med Assoc J. 2011; 13:216 – 219.
21. Mathews R, Peterson ED, Li S, Roe MT, Glickman SW, Wiviott SD, Saucedo JF, Antman EM, Jacobs AK, Wang TY. Use of emergency medical service transport among patients with ST-segment-elevation myocardial infarction: findings from the National Cardiovascular Data Registry Acute Coronary Treatment Intervention Outcomes Network Registry-Get With The Guidelines. Circulation. 2011;124:154–163.
22. Vavalle JP, Granger CB. The need for regional integrated care for ST-segment elevation myocardial infarction. Circulation. 2011;124: 851–856
23. Dhruva VN, Abdelhadi SI, Anis A, Gluckman W, Hom D, Dougan W, Kaluski E, Haider B, Klapholz M. ST-Segment Analysis Using Wireless Technology in Acute Myocardial Infarction (STAT-MI) trial. J Am Coll Cardiol. 2007;50:509–513.
24. Carstensen S, Nelson GC, Hansen PS, Macken L, Irons S, Flynn M, Kovoor P, Soo Hoo SY, Ward MR, Rasmussen HH. Field triage to primary angioplasty combined with emergency department bypass reduces treatment delays and is associated with improved outcome. Eur Heart J. 2007;28:2313–2319
2. Smith M, Singh A, McElroy D, Mittal S, Pham R. Challenges in managing ST elevation myocardial infarction during the COVID-19 pandemic. World J Cardiol [Internet]. 2021 Apr 26;13(4):76. Available from: /pmc/articles/PMC8069518/
3. Lu Q, Wang JL, Chen ZN, Fu WB, Liu HJ, Ding SF. The impact of COVID-19 on short-term prognosis of ST-segment elevation myocardial infarction patients receiving primary percutaneous coronary intervention in Wuhan China. Rev Cardiovasc Med. 2021;22(1):247–56.
4. Erol MK, Kayıkçıoğlu M, Kılıçkap M, et al. 2020. ‘Treatment delays and in-hospital outcomes in acute myocardial infarction during the COVID-19 pandemic: a nationwide study’. Anatol J Cardiol 2020;24:334–42. https://doi.org/10.14744/ AnatolJCardiol.2020.98607; PMID: 33122486.
5. Kwok CS, Gale CP, Kinnaird T, et al. ‘Impact of COVID-19 on percutaneous coronary intervention for ST-elevation myocardial infarction’. Heart 2020;106:1805–11. https://doi. org/10.1136/heartjnl-2020-317650; PMID: 32868280.
6. Sim WJ, Ang AS, Tan MC, Xiang WW, Foo D, Kong Loh K, et al. Causes of delay in Door-to-device time in south-east Asian patients undergoing primary percutaneous coronary intervention Subjects and methods. 2009; Available from: https://doi.org/10.1371/journal.pone.0185186
7. McCabe JM, Ehrin JA, Kurt SH, Prashant DB, et al. Impact of Door-to-Activation Time on Door-to-device time in Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarctions. Circulation: Cardiovascular Quality and Outcomes, American Heart Association. 2012. doi: https://doi.org/10.1161/CIRCOUTCOMES.112.966382
8. Bots SH, Peters SAE, Woodward M. Sex differences in coronary heart disease and stroke mortality: a global assessment of the effect of ageing between 1980 and 2010. BMJ Global Health 2017:2:e000298. doi:10.1136/bmjgh-2017-000298
9. Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2004;44:e1–211.
10. Steg PG, James SK, Atar D, Badano LP, Lundqvist CB, Borger MA, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). European Heart Journal. 2012;33(20):2569-619.
11. Hammad TA, Parikh M, Tashtish N, et al. 2021. ‘Impact of COVID-19 pandemic on ST-elevation myocardial infarction in a non-COVID-19 epicenter’. Catheter Cardiovasc Interv 2021;97:208–14. https://doi.org/ 10.1002/ccd.28997; PMID: 32478961.
12. Tan W, Parikh RV, Chester R, et al. 2020. ‘Single center trends in acute coronary syndrome volume and outcomes during the COVID-19 pandemic’. Cardiol Res 2020;11:256–9, diakses 5 Januari 2022. https://doi. org/10.14740/cr1096; PMID: 32595811.
13. Lee KD, Lee SB, Lim JK, et al. 2020. ‘Providing essential clinical care for non-COVID-19 patients in a Seoul metropolitan acute care hospital amidst ongoing treatment of COVID-19 patients’. J Hosp Infect 2020;106:673–7. https://doi. org/10.1016/j.jhin.2020.09.031; PMID: 33011308.
14. Dharma S, Iwan D, Isman F, Siska SD, Dian Z, et al. 2021. ‘Performance of Primary Angioplasty for STEMI during the COVID-19 Outbreak’. Int J Angiol 2021;30:148-154. https://doi.org/ 10.1055/s-0041-1727133. ISSN 1061-1711.
15. Berger PB, Ellis SG, Holmes DR, et al. 1999. ‘Relationship between delay in performing direct coronary angioplasty and early clinical outcome in patients with acute myocardial infarction.’ Circulation 1999;100:14–20. https://doi.org/10.1161/01. cir.100.1.14; PMID: 10393675
16. De Luca G, Suryapranata H, Ottervanger JP, Antman EM. 2004. ‘Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction’. Circulation 2004;109:1223–5. https://doi.org/10.1161/01.cir.0000121424.76486.20; PMID: 15007008.
17. Khrisnan VS, Manoj R, et al. ‘Door to balloon time in patients presenting with acute ST elevation myocardial infarction and time factors influencing it; an observational study from a tertiary care teaching hospital in India’. Indian Heart Journal 73 (2021) 359—361. https://doi.org/10.1016/j.ihj.2021.02.008
18. Rathore SS, Curtis JP, Chen J, et al. Association of Door-to-device time and mortality in patients admitted to hospital with ST elevation myocardial infarction: national cohort study. BMJ (Clin Res Ed). 2009;338:b1807. https://doi.org/10.1136/bmj.b1807.
19. Dhungel S, Rabi M, Chandramani A, Arun M, Rajib R, Ranjit S, Himanshu N, Binaya R, Dharmanath Y. Door-to-device time and the determining factors in a tertiary cardiac center in Nepal. Indian Heart Journal. 2018;70:S309–S312. https://doi.org/10.1016/j.ihj.2018.07.011
20. Lubovich A, Hamood H, Behar S, Rosenchein U. Bypassing the emergency room to reduce Door-to-device time and improve outcomes of patients with ST elevation myocardial infarction: the Acute Coronary Syndrome Israeli Survey experience. Isr Med Assoc J. 2011; 13:216 – 219.
21. Mathews R, Peterson ED, Li S, Roe MT, Glickman SW, Wiviott SD, Saucedo JF, Antman EM, Jacobs AK, Wang TY. Use of emergency medical service transport among patients with ST-segment-elevation myocardial infarction: findings from the National Cardiovascular Data Registry Acute Coronary Treatment Intervention Outcomes Network Registry-Get With The Guidelines. Circulation. 2011;124:154–163.
22. Vavalle JP, Granger CB. The need for regional integrated care for ST-segment elevation myocardial infarction. Circulation. 2011;124: 851–856
23. Dhruva VN, Abdelhadi SI, Anis A, Gluckman W, Hom D, Dougan W, Kaluski E, Haider B, Klapholz M. ST-Segment Analysis Using Wireless Technology in Acute Myocardial Infarction (STAT-MI) trial. J Am Coll Cardiol. 2007;50:509–513.
24. Carstensen S, Nelson GC, Hansen PS, Macken L, Irons S, Flynn M, Kovoor P, Soo Hoo SY, Ward MR, Rasmussen HH. Field triage to primary angioplasty combined with emergency department bypass reduces treatment delays and is associated with improved outcome. Eur Heart J. 2007;28:2313–2319
Published
2024-09-20
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How to Cite
Firdaus, I., Juzar, D., Dewanggi, B., Nurfitri, S., Utarini, A., & Djasri, H. (2024). Timeframe Factors of Door-to-Device Time During Pandemic Situation in a Tertiary Cardiovascular Centre in Indonesia. Indonesian Journal of Cardiology, 44(4), 131-41. https://doi.org/10.30701/ijc.1649
Section
Clinical Research
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