Saving Time Saving Lives - Heartline Fall 2012 - Montefiore Einstein Center for Heart and Vascular Care - New York City

Montefiore cardiologists bring lifesaving intervention to Bronx hospitals

It's a well-established fact that the faster heart attack patients receive care the better the results. Cardiologists at Montefiore Medical Center recognize this and have formed two rapid response teams that are on call to deliver emergency percutaneous coronary intervention (PCI) to heart attack patients at Bronx-Lebanon Hospital, St. Barnabas Hospital, and Montefiore's Weiler and Moses Campuses.

"A successful PCI program requires skilled operators, clinical resources and organizational leadership," says Mario J. Garcia, MD, Professor and Chief, Cardiology, and Co-Director, Montefiore Einstein Center for Heart and Vascular Care. "Some of the hospitals to which we provide this service are too small to have enough clinical volume to be self-sufficient 24 hours a day, seven days a week. At the same time, they provide better service to their community when they can take care of a patient experiencing a heart attack as early as possible. So rather than taking the time to transfer patients to Montefiore, we have teams of interventional cardiologists and nurses who bring their expertise to the patient."

When a patient dials 911 complaining of chest pain or other heart attack symptoms, an ambulance responds, and within 10 minutes of arrival emergency responders perform an electrocardiogram (EKG). The results are transmitted electronically to the hospital where the patient will be transported. If that hospital is one of the aforementioned, then the EKG transmission activates Montefiore's cardiology interventional team.

"Typically, our team is able to get to the hospital before or at the same time as the patient," says Mark Greenberg, MD, Director, Cardiac Catheterization, at Montefiore, and Professor, Clinical Medicine, and Associate Professor, Radiology, at Einstein. "Once the patient arrives, he or she is fast-tracked to the cath lab, where we perform angioplasty. The whole process-from the time the patient enters the hospital to the time we deploy the balloon- consistently takes less than 90 minutes, placing us below the national door-to-balloon benchmark."

According to Dr. Greenberg, the success of this process rests heavily upon the fire department's electronic EKG technology, put in place a year ago by David Prezant, MD, Chief Medical Officer of the New York City Fire Department and a physician in Montefiore's Division of Pulmonary Medicine.

"Our interventionalists are among the best; however, to meet that 90-minute mark with a transport requires immediate access to accurate information," he says. "The electronic EKG has helped to improve outcomes by ensuring that patients are directed to hospitals that are appropriately equipped to care for them, while giving the clinical team on the receiving end a heads-up on the patient's condition."

Dr. Greenberg adds that the Nextel phone system that the intervention-alists use has also helped shave the teams' response time by promptly notifying them when the fire department sends an EKG and when a patient is en route.

"It's amazing to think that a patient can now be transported from a sixth-floor walk-up and receive PCI in under two hours," says Dr. Greenberg. "I think that as the EKG technology evolves we will see these response times get even faster."