Determinants of short and long door-to-balloon time in current primary percutaneous coronary interventions
Takunori Tsukui1, Kenichi Sakakura2,3, Yousuke Taniguchi1
1Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Insights
Transfers from local hospitals were linked to shorter door-to-balloon times in ST-segment elevation myocardial infarction (STEMI) patients. This highlights the need for pre-hospital ECG systems to improve STEMI care.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Services Research
Background:
- Primary percutaneous coronary interventions (PCI) are crucial for ST-segment elevation myocardial infarction (STEMI) patients.
- Door-to-balloon time (DTBT) is a critical metric influencing mortality and morbidity in STEMI.
- Optimizing DTBT requires understanding its determinants.
Purpose of the Study:
- To identify factors associated with short and long door-to-balloon times (DTBT) in STEMI patients undergoing primary PCI.
- To analyze the relationship between patient transfer status and DTBT.
- To evaluate the impact of patient severity (Killip class) on DTBT.
Main Methods:
- Retrospective analysis of 214 STEMI patients' hospital records.
- Categorization of patients into short (<60 min), intermediate (60-120 min), and long (>120 min) DTBT groups.
- Multivariate analysis to determine significant associations with DTBT, including transfer status and Killip class.
Main Results:
- In-hospital mortality was significantly higher in the long DTBT group (24.2%) compared to intermediate (5.8%) and short (0%) groups.
- Transfer from local clinics or hospitals was significantly associated with shorter DTBT (OR 3.43).
- Higher Killip class (3 or 4) was inversely associated with short DTBT (OR 0.20).
Conclusions:
- Transfer from local healthcare facilities is a key determinant of shorter DTBT in STEMI patients.
- The findings suggest limitations in Japan's current ambulance system, particularly the lack of pre-hospital ECG transmission.
- Implementing a pre-hospital ECG system is recommended to improve STEMI management and reduce DTBT.
Abstract:
Primary percutaneous coronary interventions (PCI) have been developed to improve clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). In primary PCI, the door-to-balloon time (DTBT) is closely associated with mortality and morbidity. The purpose of this study was to find determinants of short and long DTBT. From our hospital record, we included 214 STEMI patients, and divided into the short DTBT group (DTBT < 60 min, n = 60), the intermediate DTBT group (60 min ≤ DTBT ≤ 120 min, n = 121) and the long DTBT group (DTBT > 120 min, n = 33). In-hospital mortality was highest in the long DTBT group (24.2%), followed by the intermediate DTBT group (5.8%), and lowest in the short DTBT group (0%) (< 0.001). Transfers from local clinics or hospitals (OR 3.43, 95% CI 1.72-6.83, P < 0.001) were significantly associated with short DTBT, whereas Killip class 3 or 4 (vs. Killip class 1 or 2: OR 0.20, 95% CI 0.06-0.64, P = 0.007) was inversely associated with short DTBT in multivariate analysis. In conclusion, transfer from local clinics/hospitals was associated with short DTBT. Our results may suggest the current limitation of ambulance system, which does not include pre-hospital ECG system, in Japan. The development of pre-hospital ECG system would be needed for better management in STEMI.
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