CONGRESS ABSTRACT

The DIDO is the time between the patient ‘s arrival in a center without haemodynamics and the departure by ambulance towards the center with haemodynamics. It affects the D2B and the patient ‘s prognosis and is an indicator of the effectiveness of the performance on STEMI care when it is less than 30 minutes. From 2009, a protocol was developed on the management of PCI in our hospital, whose primary objective was the containment of DIDO within 30 minutes. After the application of this protocol we went to evaluate our performance on patients who arrived consecutively from 1 January 2022 to 31 December 2022 at the San Benedetto del Tronto ED, Spoke centre not equipped with haemodynamics. Inclusion criteria: age over 18 years, chest pain <12 hours, discharge diagnosis of STEMI ACS. Excluded 2 patients with cardiac arrest admitted to the ICU, 2 patients with diagnostic uncertainty centralized subsequently, 2 patients with no indication for PCI in emergency admitted to the Cardiac Intensive Care Unit, there are 35 patients, 10 females (29%) and 25 males (71%), with an average age of 64.57 years. Comorbidities were present in 71% of patients (cardiovascular pathologies, diabetes and obesity), while in 29% of patients no comorbidity was present. No comorbidity was observed in 60% of patients between 18 and 55 years and in 30% of patients between 65 and 75 years. We evaluate our performance by comparing the trend, over the years, of this indicator. A reduction in the average DIDO was achieved from 56 minutes in 2014 to 33 minutes in 2022 reaching the value of 17 minutes in 75% of cases. The percentage of cases outside the cut off is 25.71%. We tried to hypothesize the causes responsible for a DIDO>30 minutes: an inappropriate attribution of the priority color code to Triage, the presence of comorbidities. In reality, as well as data from international literature, cases of DIDO >30 minutes were associated with delay accumulated for necessary specialist consultations for difficult to interpret ECGs and the delay of the transport the patient to the Hub hospital. To conclude is necessary direct centralization of STEMI ACS patients from 118 to haemodynamics and reduce centralization decision-making times by identifying criteria facilitating the transfer decision in cases of difficult-to-interpret ECGs.