Current status of emergency care for ST-elevation myocardial infarction in an urban setting in Japan
Naoki Nakayama1, Kazuo Kimura, Tsutomu Endo
1Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
Insights
Door-to-balloon time (DTB) is crucial for ST-elevation myocardial infarction (STEMI) outcomes. A tertiary emergency center achieved faster DTB and lower mortality compared to community hospitals, highlighting the need for improved systems.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Systems Research
Background:
- Door-to-balloon time (DTB) is a key predictor for ST-elevation myocardial infarction (STEMI) patient outcomes.
- Primary percutaneous coronary intervention (PCI) is the main reperfusion strategy in Japan.
- The speed of reperfusion therapy in Japanese hospitals remains largely unexamined.
Purpose of the Study:
- To compare DTB and clinical outcomes between a tertiary emergency center (TEC) and community hospitals (CHs).
- To identify factors associated with prolonged DTB in community hospitals.
- To assess the impact of DTB on 30-day mortality in STEMI patients.
Main Methods:
- Retrospective analysis of 369 STEMI patients undergoing emergency coronary angiography.
- Comparison of DTB metrics between TEC and 11 CHs.
- Logistic regression analysis to identify predictors of prolonged DTB and mortality.
Main Results:
- Median DTB was significantly shorter at the TEC (63 min) vs. CHs (104 min).
- DTB within 90 minutes was achieved in 96% of TEC patients versus 39% of CH patients.
- Prolonged DTB (>90 min) was an independent predictor of 30-day mortality (OR 12.6).
Conclusions:
- Tertiary emergency centers demonstrate superior DTB performance compared to community hospitals.
- Factors like off-hours presentation and non-cardiologist initial assessment prolong DTB in CHs.
- Establishing emergency cardiac care systems aiming for DTB within 90 minutes is essential for improving STEMI outcomes.
Background:
The door-to-balloon time (DTB) is an important predictor of the outcome for patients with ST-elevation myocardial infarction (STEMI). In Japan, percutaneous coronary intervention (PCI) can be performed at many hospitals, and the predominant strategy for reperfusion therapy is primary PCI. However, it remains unclear how rapidly reperfusion is achieved at these hospitals.
Methods And Results:
The study group comprised 369 patients with STEMI who presented within 12 h of symptom onset to a tertiary emergency center (TEC) or at 11 community hospitals (CHs) in 2006 and underwent emergency coronary angiography. Median DTB was shorter in the TEC (63 vs 104 min, P<0.001), and the rate of DTB within 90 min was higher in the TEC (96% vs 39%, P<0.001). Lateral myocardial infarction, presentation during off-hours, and non-cardiologist as the first-contact physician were significantly associated with a prolonged DTB in CHs. There was a trend toward lower 30-day mortality from all causes in the TEC (2.0% vs 4.8%, P=0.08). Multiple logistic regression analysis demonstrated that prolonged DTB (>90 min) was an independent predictor of 30-day mortality (odds ratio 12.6; 95% confidence interval 1.85-86.2, P=0.01).
Conclusions:
Establishment of emergency cardiac care systems with the goal of DTB within 90 min is required in PCI-capable hospitals to improve clinical outcomes.
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