• William B Borden, Michelle M Fennessy, Anne M O'Connor, Robert A Mulliken, Linda Lee, Sandeep Nathan, Jearlyn Nichols, and John J Lopez.
• Cornell University, Division of Cardiology, Department of Medicine, Weill Medical College, New York, New York, USA.
• Catheter Cardiovasc Interv. 2012 May 1;79(6):851-8.

ObjectiveTo assess a quality improvement initiative aimed at minimizing door-to-balloon (DTB) times for ST-elevation myocardial infarction (STEMI) patients presenting without chest pain.BackgroundTimely percutaneous coronary intervention (PCI) is the cornerstone of STEMI care. The absence of chest pain delays PCI. Improvements in DTB times may need to focus on atypical presentation patients.MethodsWe compared DTB times on all STEMI patients admitted through the emergency department who underwent PCI before (Phase I; October 2004-June 2007) and after (Phase II; July 2007-October 2009) the quality improvement effort, which mandated rapid electrocardiogram (ECG) triage for an expanded list of presenting symptoms.ResultsIn Phase I (69 patient, 60 with chest pain), patients with chest pain had a shorter mean time to first ECG (ECG Interval) by 32.0 min (P < 0.01) and nonsignificantly faster mean DTB time by 42.0 min (P = 0.07) compared to patients who presented without chest pain. In Phase II (62 patients, 56 with chest pain) compared to Phase I, mean ECG interval decreased by 44 min (P = 0.02) and mean DTB time by 99 min (P = 0.01) in patients without chest pain, eliminating the differences in ECG intervals between typical and atypical presentations (12 min vs. 11 min, P = 0.91). Multivariable analysis controlling for on/off hours and patient characteristics confirmed these findings.ConclusionsA simple modification of emergency room ECG triage protocol, which expands indications for rapid ECG performance, was successful in improving rapid reperfusion for patients with STEMI presenting without chest pain.Copyright © 2011 Wiley-Liss, Inc.

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