Abstract 15875: Relationship Between Door to Balloon Time Variability and Outcomes in Patients With ST Elevation Myocardial Infarction

Introduction: We aimed to determine the impact of a comprehensive STEMI protocol (CSP) on door to balloon time (D2BT) variability and patient outcomes. Methods: On 7/15/14 we implemented a CSP based on 4 key elements: (1) checklist for initial triage and management (2) ED physician cath lab activation criteria independent of cardiology consult (3) cath lab readiness 24/7/365 and (4) radial first approach for primary PCI. We reviewed all 1273 STEMI patients (723 pre-CSP and 550 post-CSP) treated with primary PCI from 1/1/2011 to 12/31/2016 at our center, and we assessed the impact of a CSP on D2BT variability and patient outcomes. Results: Patient demographics and comorbidities were similar between the pre- and post-CSP groups. Median D2BT was faster in both primary ED-presenting (68min vs 53min, P th to 5 th percentile range of D2BT decreasing from 235min (IQR 97 min) to 126 min (IQR 29 min) after implementation of the CSP (P th to 5 th percentile quarterly D2BT range was associated with a 26% decrease in the odds of in-hospital mortality (OR 0.74, 95% CI 0.60 - 0.92, P=0.006) after adjusting for clinical variables known to be associated with PCI mortality. Conclusions: Implementation of a CSP is associated with improved mortality through reduced care variability among patients with STEMI.