Contribution of First Contact With a Cardiologist to the Door-to-Cardiac Catheterization Laboratory Time in Patients...

Area of Science:

• Cardiology
• Acute Myocardial Infarction Research
• Cardiovascular Intervention

Background:

• Current guidelines advocate for early revascularization in acute myocardial infarction (AMI) patients experiencing cardiogenic shock (CS).
• However, achieving guideline-recommended first medical contact-to-device times remains a challenge, with only 40% of patients meeting the criteria.

Purpose of the Study:

• To investigate factors contributing to treatment delays in AMI patients with CS.
• To assess the impact of door-to-cardiac catheterization laboratory (D2C) time on in-hospital mortality.

Main Methods:

• Retrospective analysis of 369 patients with AMI complicated by CS from the Kanagawa-Acute Cardiovascular Registry.
• Patients were divided into two groups based on median D2C time: ≤39 minutes and >39 minutes.
• Multivariate logistic regression analysis was used to identify independent predictors of mortality.

Main Results:

• A D2C time of ≤39 minutes was associated with a significantly lower in-hospital mortality rate (18.8% vs. 37.6%, P<0.001).
• Patients with shorter D2C times were more likely to be initially seen by a cardiologist and present with chest pain.
• Delays in D2C time were independently linked to non-cardiologist initial contact, absence of chest pain, higher heart rate, and elevated creatinine levels.

Conclusions:

• Shorter D2C times (≤39 minutes) are correlated with reduced mortality in AMI patients with CS.
• Optimizing in-hospital workflows and ensuring cardiologists are the primary responders can decrease D2C time and improve patient outcomes.