{"id":2649,"date":"2010-08-20T16:22:27","date_gmt":"2010-08-20T20:22:27","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?p=2649"},"modified":"2011-07-19T17:44:16","modified_gmt":"2011-07-19T21:44:16","slug":"door-to-balloon-d2b-time-the-wrong-performance-measure","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2010\/08\/20\/door-to-balloon-d2b-time-the-wrong-performance-measure\/","title":{"rendered":"Door to Balloon (D2B) Time: The Wrong Performance Measure?"},"content":{"rendered":"<p>The authors of a\u00a0<a href=\"http:\/\/jama.ama-assn.org\/cgi\/reprint\/304\/7\/763\">recently published study <\/a>evaluated the association between system delay (i.e., time from<span style=\"color: #000000;\"> the patient&#8217;s first <\/span>contact\u00a0with the health care system to initiation of reperfusion) and outcome in STEMI patients transported by EMS and treated with primary PCI.\u00a0 Some patients were <span style=\"color: #000000;\">triaged directly to a PCI center, whereas others were transported to their local hospitals before transfer to a PCI center.<\/span><\/p>\n<p><span style=\"color: #000000;\">Compared with patients triaged directly to a PCI center,\u00a0those transferred to a PCI center had a <strong><em>shorter D2B time<\/em><\/strong> (29 vs. 39 min, <em>P<\/em>&lt;0.001) but a <strong><em>longer total health system delay<\/em><\/strong> (240 min vs. 172 min; <em>P<\/em>&lt;0.001). Importantly, this delay substantially influenced long-term (3.4-year) mortality, which was\u00a015% of those with a treatment delay of 0-60 minutes, 23% with a delay of 61-120 minutes, 28% with a delay of 121-180 minutes, and 31% with a delay of 181-360 minutes (<em>P<\/em>&lt;0.001).<\/span><\/p>\n<p><span style=\"color: #000000;\">Apparently, transfer to another facility for primary PCI\u00a0might not\u00a0constitute\u00a0optimal care of the AMI patient. Given regional\u00a0variations in treatment delay, <em><strong><span style=\"color: #993300;\">how do you decide how to treat these patients<\/span><\/strong><\/em><span style=\"color: #993300;\">?<\/span><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The authors of a\u00a0recently published study evaluated the association between system delay (i.e., time from the patient&#8217;s first contact\u00a0with the health care system to initiation of reperfusion) and outcome in STEMI patients transported by EMS and treated with primary PCI.\u00a0 Some patients were triaged directly to a PCI center, whereas others were transported to their [&hellip;]<\/p>\n","protected":false},"author":214,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1,9],"tags":[303,245,302],"class_list":["post-2649","post","type-post","status-publish","format-standard","hentry","category-general","category-interventional-cardiology","tag-d2b","tag-mi","tag-primary-pci"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/2649","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/214"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=2649"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/2649\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=2649"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=2649"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=2649"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}