Barriers Associated With Door-to-Balloon Delay in Contemporary Japanese Practice
Nobuhiro Ikemura1, Mitsuaki Sawano1, Yasuyuki Shiraishi1
1Department of Cardiology, Keio University School of Medicine.
Insights
Achieving door-to-balloon times under 90 minutes for ST-elevation myocardial infarction (STEMI) remains a challenge. Predictors of delay include patient comorbidities and off-hour procedures, with high-volume centers performing better.
Area of Science:
- Cardiology
- Interventional Cardiology
- Healthcare Quality Improvement
Background:
- Door-to-balloon (DTB) time is a critical quality metric for ST-elevation myocardial infarction (STEMI) management.
- Many STEMI patients, especially outside the US and Europe, do not meet the ≤90 minute DTB goal.
- Improving DTB times is crucial for optimal STEMI patient outcomes.
Purpose of the Study:
- To analyze time trends in DTB times for STEMI patients undergoing primary percutaneous coronary intervention (PCI).
- To identify independent predictors of delayed DTB time (>90 minutes).
- To evaluate the impact of institutional volume on achieving timely DTB metrics.
Main Methods:
- Analysis of 2,428 STEMI patients from the JCD-KiCS registry (2008-2013).
- Inclusion criteria: primary PCI within 12 hours of symptom onset.
- Statistical analysis to assess time trends and identify predictors of delayed DTB time.
Main Results:
- Median DTB time was 90 minutes (IQR, 68-115 min) with no significant year-to-year change.
- Predictors of delayed DTB time included peripheral artery disease, prior revascularization, off-hour arrival, age >75 years, heart failure, and use of IABP or VA-ECMO.
- High-volume PCI centers (≥200 PCI/year) achieved shorter DTB times compared to low-volume centers (<200 PCI/year).
Conclusions:
- Approximately half of STEMI patients in this cohort did not achieve the target DTB time of ≤90 minutes.
- Targeting interventions for elderly patients, those with multiple comorbidities, and addressing off-hour PCI may improve DTB times.
- Institutional volume is a significant factor in achieving timely STEMI reperfusion therapy.
Background:
Door-to-balloon (DTB) time ≤90 min is an important quality indicator in the management of ST-elevation myocardial infarction (STEMI), but a considerable number of patients still do not meet this goal, particularly in countries outside the USA and Europe.
Methods And Results:
We analyzed 2,428 STEMI patients who underwent primary PCI ≤12 h of symptom onset who were registered in an ongoing prospective multicenter database (JCD-KiCS registry), between 2008 and 2013. We analyzed both the time trend in DTB time within this cohort in the registry, and independent predictors of delayed DTB time >90 min. Median DTB time was 90 min (IQR, 68-115 min) during the study period and there were no significant changes with year. Predictors for delay in DTB time included peripheral artery disease, prior revascularization, off-hour arrival, age >75 years, heart failure at arrival, and use of IABP or VA-ECMO. Notably, high-volume PCI-capable institutions (PCI ≥200/year) were more adept at achieving shorter DTB time compared with low-volume institutions (PCI <200/year).
Conclusions:
Half of the present STEMI patients did not achieve DTB time ≤90 min. Targeting the elderly and patients with multiple comorbidities, and PCI performed in off-hours may aid in its improvement.
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