Abstract
Objectives: Acute myocardial infarction (AMI) is a typical emergency condition which has specific target therapy timeframes that are recommended by several guidelines and therefore is a suitable condition for evaluating quality of care. However, little is known about the present situation of these timeframes in Japan. The aim of our study was to evaluate emergency department performance for patients with AMI in Japan.
Methods: We evaluated the door-to-ECG time and door-to-catheter-lab time in 78 patients with AMI receiving percutaneous coronary intervention (PCI) in the Emergency Department (ED) of a single hospital in Japan during in the course of one year.
Results: The door-to-ECG mean time was 9.7 ± 4.8 minutes (median 8 min) with 77% of patients receiving an ECG within 10 min of arrival. The door-to-catheter-lab time was 55.7 ± 32.4 min (43 min). The door-to-ECG times during regular work hours and after-hours/weekend were 10.5 ± 1.7 min (8 min) and 9.4 ± 0.9 min (7.5 min) (p=0.462); for, door-to-catheter-lab time the times were 50.2 ± 9.9 min (35 min) and 54.1 ± 9.0 min (49 min) (p=0.506), respectively. Neither difference was founded to be statistically significant. The door-to-ECG times of patients with and without chest pain were 7.9 ± 0.6 min (7 min) and 15.1 ± 2.4 min (11.5 min), respectively and the difference was statistically significant (p<0.001), whereas door-to-catheter-lab times were 47.3 ± 4.7 min (32 min) and 80.3 ± 23.0 min (56.5 min), respectively, the difference was not statistically significant (p=0.056). The door-to-ECG times of patients presenting by private conveyance and ambulance were 15.7 ± 9.5 min (11.5 min) and 7.5 ± 4.8 min (7 min), respectively, and the difference was statistically significant (p<0.001), whereas in door-to-catheter-lab time was 67.9 ± 27.2 min (60 min) and 51.2 ± 69.4 min (31 min), respectively and the difference was not statistically significant (p=0.324).
Conclusion: We observed no differences in door-to-ECG time and door-to-catheter-lab time in terms of the time of day or week of presenting. Our study also brought into light the fact that atypical presentation and presenting by private conveyance significantly increased the time to appropriate management. These results warrant further investigation into how these patients are managed, and how to develop the diagnostic skills of emergency physicians.
