For patients with ST Elevation Myocardial Infarction (STEMI), the treatment of choice is emergency Percutaneous Coronary Intervention (PCI). This treatment is available at Changi General Hospital round the clock for suitable patients.
The time interval between the patient's arrival at the emergency department and the first device introduced with the aim of restoring perfusion to the coronary artery (termed time-to-reperfusion or door-to-balloon time) should be as short as possible, because shorter door-to-balloon times are associated with better outcomes and reduced mortality1, 2. American Heart Association guidelines3 recommend that door-to-balloon times should be less than 90 minutes.
In Changi General Hospital, we have implemented several strategies to reduce our door-to-balloon times, including direct activation of the PCI team by the emergency physician, a streamlined process and expecting the PCI team to be in the cardiac catheterization laboratory within 20 minutes of being called, even outside of office hours. Our door-to-balloon times have also improved after, in a nationwide initiative, ambulance paramedics began to transmit prehospital ECG's to emergency departments so that early diagnosis of STEMI could be made.
The CGH AMI and heart failure programmes were certified by JCI in 2007 - the first Clinical Care Program Certification (previously known as Disease or Condition Specific Care Certification) programs to achieve this outside USA, and we were re-certified in 2010. The CGH AMI and heart failure programs are the only JCI certified disease specific programs in Singapore.
1. Rathore SS, Curtis JP, Chen J, Wang Y, Nallamothu BK, Epstein AJ et al. Association of door-to-balloon time and mortality in patients admitted to hospital with ST elevation myocardial infarction : national cohort study. BMJ 2009; 338 : b1807.
2. McNamara RL, Wang Y, Herrin J, Curtis JP, Bradley EH, Magid DJ et al. Effect of door-to-balloon time on mortality in patients with ST-segment elevation myocardial infarction. J Am Coll Cardiol 2006; 47 : 2180-6.
3. Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M. ACC/AHA Guidelines for the management of patients with ST elevation myocardial infarction. Circulation 2004; 110 : e82 – e292.