Shorter door-to-balloon time, better long-term clinical outcomes in ST-segment elevation myocardial infarction
Ryota Nishio1, Manabu Ogita1, Satoru Suwa1
1Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan.
Insights
Shorter door-to-balloon times significantly improve long-term outcomes for ST-segment elevation myocardial infarction (STEMI) patients receiving primary percutaneous coronary intervention (PPCI). Reducing DTB time is crucial for better clinical results in STEMI care.
Area of Science:
- Cardiology
- Clinical Research
- Public Health
Background:
- The long-term clinical impact of door-to-balloon (DTB) time in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI) requires further elucidation.
- Contemporary data on the association between DTB time and long-term outcomes in STEMI patients treated with PPCI is limited.
- Understanding this relationship is critical for optimizing treatment protocols and improving patient prognosis.
Purpose of the Study:
- To investigate the association between door-to-balloon (DTB) time and long-term clinical outcomes in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PPCI).
- To stratify STEMI patients based on DTB time and analyze the incidence of major adverse cardiovascular events over a three-year follow-up period.
- To provide evidence-based recommendations for reducing DTB time to improve long-term patient outcomes.
Main Methods:
- Analysis of 1639 STEMI patients who underwent PPCI within 12 hours of symptom onset, drawn from a prospective, nationwide, multicenter registry (J-MINUET database).
- Patients were stratified into four groups based on DTB time: <45 min, 45-60 min, 61-90 min, and >90 min.
- The primary endpoint, a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, cardiac failure, and urgent revascularization, was assessed up to 3 years using landmark analysis from day 31.
Main Results:
- A significant, time-dependent increase in the primary endpoint rate was observed with longer DTB times over the 3-year follow-up (10.2% vs. 15.3% vs. 16.2% vs. 19.3%).
- Higher logarithm-transformed DTB time was independently associated with an increased risk of adverse long-term clinical outcomes.
- These findings persisted even after adjusting for other independent variables, highlighting the robust association between DTB time and long-term prognosis.
Conclusions:
- Shorter door-to-balloon (DTB) times are associated with significantly better long-term clinical outcomes in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PPCI).
- The study underscores the importance of minimizing DTB time in contemporary clinical practice.
- Further efforts to shorten DTB time are strongly recommended to improve long-term clinical outcomes and reduce adverse events in STEMI patients.
Background:
The impact of shorter door-to-balloon (DTB time on long-term outcomes in ST-segment elevation myocardial infarction (STEMI treated with primary percutaneous coronary intervention (PPCI has not been fully elucidated.
Methods:
We investigated 3283 consecutive patients with acute myocardial infarction selected from a prospective, nationwide, multicenter registry (J-MINUET database comprising 28 institutions in Japan between July 2012 and March 2014. Among the study population, we analyzed 1639 STEMI patients who had PPCI within 12 h of onset. Patients were stratified into four groups (DTB time < 45 min, 45-60 min, 61-90 min, >90 min. The primary endpoint was a composite of all-cause death, non-fatal MI, non-fatal stroke, cardiac failure, and urgent revascularization for unstable angina up to 3 years. We performed landmark analysis for incidence of the primary endpoint from 31 days to 3 years among the four groups.
Results:
The primary endpoint rate from 31 days to 3 years increased significantly and time-dependently with DTB time (10.2 % vs. 15.3 % vs. 16.2 % vs. 19.3 %, respectively; log-rank p = 0.0129. Higher logarithm-transformed DTB time was associated with greater risk of a primary endpoint from 31 days to 3 years, and the increased number of adverse long-term clinical outcomes persisted even after adjusting for other independent variables.
Conclusion:
Shorter DTB time was associated with better long-term clinical outcomes in STEMI patients treated with PPCI in contemporary clinical practice. Further efforts to shorten DTB time are recommended to improve long-term clinical outcomes in STEMI patients.
Trial Registration:
UMIN Unique trial Number: UMIN000010037.
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