Delay in Performing Primary Angioplasty: Is it Due to a Reason Related to the Patient or to the Healthcare System?

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Abstract

Introduction
One of the inconveniences in the general utilization of primary angioplasty (PTCA) would seem to be the delay in its application. Most of present data come from clinical trials from other countries, whereas little is known about its application in the regular practice in our country.

Objectives
To analize the periods of time needed for each stage of a PCTA in a center where the treatment of choice is used as a first step for a time-optimization program, and to determine if the delay is due to a situation related to the patient or to the healthcare system.

Material and Methods
This is a prospective observational study in patients with AMI lasting less than 12 hours. The “patient time” was counted from the onset of the symptoms to arrival at hospital, and the “medical care time” was determined from hospital arrival to balloon inflation.

Results
PCTA was performed in 224 patients admitted with diagnosis of AMI. The median values (25th to 75th percentile) were “patient time”: 60 minutes (40-150), “medical care time”: 93 minutes (72-128). “Medical care time” includes: time 1 (hospital arrival-EICT activation): 20 minutes (10-45), time 2 (EICT activation-admission to cath lab): 38 minutes (23-52), time 3 (admission to cath lab- first balloon inflation): 31 minutes (21-45).

Conclusions
“Patient time” represents less than half the total time consumed. “Medical care time” determines the higher delay for the procedure; therefore, more emphasis should be placed in improving this time, within which EICT activation-first balloon inflation time constitutes a key factor.