A rapid-response alphanumeric paging design decreases door-to-balloon times in patients undergoing primary percutaneous coronary intervention for ST elevation acute myocardial infarction

Introduction: In acute ST elevation myocardial infarction (STEMI), rapid reperfusion of the infarcted artery improves cardiovascular outcomes; however, many hospitals have difficulty achieving recommended times. We hypothesized that a Rapid-Response Alphanumeric Paging Design (RAPiD) would reduce door-to-balloon time for primary percutaneous coronary intervention (PCI) in STEMI. Methods: A chest pain algorithm and interdisciplinary team was established in December 2000. In August 2002, RAPiD was instituted to transmit the diagnosis and location of a STEMI to the chest pain team through a speed-dial button. All patients presenting to our emergency department from February 2002 through July 2003 with STEMI were included. Exclusion criteria included lack of chest pain, cardiopulmonary arrest before PCI, and catheterization or PCI not performed. Outside-referral STEMI, in-patient STEMI, and failed thrombolysis patients were excluded. Data was obtained from medical records. Log transform of door-to-balloon (DTB) times was performed. Results: Forty-seven events satisfied inclusion and exclusion criteria with 32 occurring after RAPiD (post-RAPiD). Fifteen events occurred during on-hours (8 AM to 7 PM on weekdays). Mean untransformed DTB times pre- and post-RAPiD were 162 ± 137 (standard deviation) minutes and 112 ± 41 minutes. The main effects analysis of variance model showed a significant reduction in post-RAPiD DTB time (P = 0.03) with a mean reduction of 26% during off-hours and 20% during on-hours. The post-RAPiD estimate of mean DTB time, derived from the antilog of the log transform, was 96.7 minutes (95% confidence interval, 83.7-111.7). Conclusions: The institution of RAPiD in a hospital with a preexisting chest pain algorithm significantly decreases DTB times so as to satisfy current ACC/AHA guidelines.