Comparing Door-To-Balloon Time between ST-Elevation Myocardial Infarction Electrocardiogram and Its Equivalents
Youngchul Choi1, Kiwook Kim1, Joo Suk Oh1
1Department of Emergency Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 271 Cheonbo-ro, Uijeongbu-si 11765, Korea.
Insights
Patients with ST-elevation myocardial infarction equivalents experienced longer door-to-balloon times. Prompt recognition of these atypical electrocardiographic findings is crucial for timely intervention and improved outcomes.
Area of Science:
- Cardiology
- Emergency Medicine
- Diagnostic Imaging
Background:
- Longer door-to-balloon (DTB) times in ST-elevation myocardial infarction (STEMI) correlate with poor patient outcomes.
- A subset of acute coronary occlusions presents with atypical electrocardiographic (ECG) findings, termed STEMI-equivalents.
- The impact of STEMI-equivalents on DTB times requires investigation.
Purpose of the Study:
- To determine if DTB times are delayed in patients with STEMI-equivalent ECGs compared to typical STEMI.
- To identify STEMI-equivalent ECG as an independent predictor of delayed DTB time.
Main Methods:
- Retrospective analysis of acute coronary syndrome patients undergoing primary percutaneous coronary intervention (pPCI).
- Classification of ECGs into STEMI and STEMI-equivalent groups.
- Comparison of DTB times and logistic regression analysis for predictors of delayed DTB (>90 min).
Main Results:
- STEMI-equivalent ECGs were identified in 12.8% of 180 patients.
- DTB time was significantly longer in STEMI-equivalent patients (89 min) versus STEMI patients (81 min; p=0.001).
- STEMI-equivalent ECG was an independent predictor of delayed DTB time (OR 4.692; p=0.004).
Conclusions:
- Patients with STEMI-equivalent ECGs experience significantly delayed DTB times.
- Early recognition of STEMI-equivalents by emergency physicians and interventional cardiologists is essential.
- Reducing DTB time in STEMI-equivalent cases may improve clinical outcomes.
Background:
In patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary interventions (pPCI), longer door-to-balloon (DTB) time is known to be associated with an unfavorable outcome. A percentage of patients with acute coronary occlusion present with atypical electrocardiographic (ECG) findings, known as STEMI-equivalents. We investigated whether DTB time for STEMI-equivalent patients was delayed.
Methods:
This is a retrospective study including patients arriving at an emergency department with the acute coronary syndrome in whom emergent pPCI was performed. ECGs were classified into STEMI and STEMI-equivalent groups. We compared DTB time, with its components, between the groups. We also investigated whether STEMI-equivalent ECG was an independent predictor of DTB time delayed for more than 90 min.
Results:
A total of 180 patients were included in the present study, and 23 patients (12.8%) presented with STEMI-equivalent ECGs. DTB time was significantly delayed in patients with STEMI-equivalent ECGs (89 (80-122) vs. 81 (70-88) min, p = 0.001). Multivariable logistic regression analysis showed that STEMI-equivalent ECG was an independent predictor of delayed DTB time (odds ratio: 4.692; 95% confidence interval: 1.632-13.490, p = 0.004).
Conclusions:
DTB time was significantly delayed in patients presenting with STEMI-equivalent ECGs. Prompt recognition of STEMI-equivalent ECGs by emergency physicians and interventional cardiologists might reduce DTB time and lead to a better clinical outcome.
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