Efforts to decrase the door to balloon time might increase the incidence of unnecessary emergency cardiac catheterization and delay appropriate care

Introduction: Door to balloon time (D2BT) is a quality measure of care for ST segment Elevation Myocardial Infarction (STEMI). We postulate that aggressive efforts to reduce D2BT may lead to increased false positive (FP) STEMI diagnoses. Methods: Retrospective analysis of 1006 consecutive patients from two yearly intervals between July 2008 to June 2010, who presented to our hospital with symptoms and EKG concerning for STEMI, was performed. During this time, successful efforts to reduce D2BT occurred. Incidence of cath lab activation (heart alerts), emergent cardiac catheterization (heart codes) were compared. We also compared the D2BT and the incidence of FP heart codes (emergent catheterization, no coronary disease) for each year Results: Recent D2BT decreased signi!cantly compared to the previous year. STEMI Incidence has remained the same but, there was a slightly increased incidence of emergent cardiac catheterization and a trend towards increased incidence of FP heart codes. Some of the latter patients had delay in receiving appropriate care for urgent non-cardiac conditions. Conclusion: Aggressively pushing the D2BT down may increase unnecessary emergent cardiac catheterization. Efforts to reduce D2BT have to be monitored systematically to avoid unnecessary procedures and delay in appropriate care for critically ill patients. Careful evaluation of the patient before emergent cardiac cath is essential.