CARDIAC CATH LAB - Mount Sinai Hospital

Michael C. Kim, MD
Director, Coronary Care
Unit, on Door-2-Balloon
Time in STEMI
This past year MSH
achieved an almost
unprecedented D2B
record of less than 90
minutes in over 95% of
our STEMI patients.
The most serious heart attack is signaled
by characteristic ST elevations on the
surface electrocardiogram; hence the
name ST segment elevation myocardial
infarction, or STEMI. Rapid intervention
in STEMI is critical because the condition,
which is triggered by a total blockage of a
coronary artery, can result in a significant
portion of the heart muscle dying due
to lack of blood supply if not cleared quickly. It’s the cardiac condition
people fear most when they say “heart attack” and with good reason;
50 percent of patients never even make it to the hospital alive.
Because patient mortality rates have remained high in this medical
emergency even as others improve, and because angioplasties are the
ideal method of treatment, the American College of Cardiology (ACC)
declared a national “Door to Balloon” (D2B) initiative in 2006, calling
on every hospital to examine performance with the goal of treating
STEMIs (by balloon catheterization, for example) within 90 minutes
of a patient’s arrival at the ER “door.” Mount Sinai, which already
had an outstanding record of performance in treating STEMIs, took
up the challenge. This past year we achieved an almost unprecedented
D2B record of less than 90 minutes in over 95 percent of our STEMI
patients, with a caseload of 150 to 200 patients annually. In one
notable instance our D2B interval was only 20 minutes! Offering these
kinds of responses when only 30 percent of hospitals nationwide are
consistently doing so is significant.
How do we do this? The simple answer is that we have examined every
detail of our program and developed better strategies for getting these
critically ill patients to the cath lab without any unnecessary delay. As
we are known to the city’s ambulance services as offering outstanding
care and rapid response, a patient suspected of a STEMI is likely to be
brought here even if it means bypassing a closer hospital without a
24 Mount Sinai Hospital Cardiac Cath Lab