STEMI is STElevation Myocardial Infarction. A type of myocardial infarction (heart attack) with characteristic ST elevation on electrocardiogram.
PCI is Percutaneous Coronary Intervention.
Primary PCI is the PCI without pharmacologic intervention before PCI procedure except those given during PCI procedure.
Direct admission: Patients who received the STEMI diagnosis at the PCI hospital.
Transferred admission: Patients have STEMI diagnosis at other (First-non PCI) hospital then transfer to PCI hospital.
“Door to Balloon time” is counting from FMC – First Medical Contact – when the diagnosis of STEMI was made, to the time start using device to open the occluded coronary artery.
For direct admission: Door to balloon time should be
For transferred admission: Door to Balloon time should be
Primary PCI vs Thrombolytic treatment for STEMI.
In case of STEMI, it has been established that primary PCI that can be accomplished within the time frame as indicated above is better than thrombolytic treatment.
Bangkok Heart Hospital Primary PCI for STEMI program
Acute Myocardial Infarction management program at Bangkok Heart Hospital has been certified by Joint Commission International 2008.
Direct admission result
Primary PCI for STEMI for direct admission patients at Bangkok Heart Hospital, 2012-2014
Consecutive cases that have the initial diagnosis at Bangkok Heart Hospital
During this period we have not used thrombolytic treatment as an initial reperfusion therapy
“Door to Balloon time”, with cases exclusion per ACC/AHA 2008 Performance Measures for Adults With ST-Elevation and Non-ST-Elevation Myocardial Infarction, as in the table below
Number of case
33
Median door to balloon time
84 Minutes
Percentage of median door to balloon time less than 90 Minutes
60.6%
Transferred admission program To achieve Primary PCI for STEMI for transferred patient ( less than 120 minutes) is very difficult or not possible in Bangkok-Thailand
Encouraging “Pharmaco-invasive” approach
Thrombolytic therapy in 30 minutes in the first (non PCI) hospital
Transfer to Bangkok Heart Hospital
Coronary angiogram-PCI in 3-24 hours from thrombolytic treatment time
Transfer to Bangkok Heart Hospital for Rescue PCI, Late or Delay PCI.
