Association between the Door-to-balloon Time and Mid-term Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction

Abstract

Objective In primary percutaneous coronary intervention (PCI), the door-to-balloon time (DTBT) is known to be associated with in-hospital death in patients with ST-segment elevation myocardial infarction (STEMI). However, little is known regarding the association between the DTBT and the mid-term clinical outcomes in patients with STEMI. The purpose of this study was to investigate the association between the DTBT and mid-term all-cause death. Methods The study population included 309 STEMI patients, who were divided into the short DTBT (DTBT<60 minutes, n=103), intermediate DTBT (DTBT 60-120 minutes, n=174) and long DTBT (DTBT >120 minutes, n=32) groups. The median follow-up period was 287 days (interquartile range: 182-624 days). Results The incidence of all-cause death in the long DTBT group was significantly higher in comparison to the other groups (p<0.001). In the multivariate Cox regression analysis, although a short DTBT [vs. intermediate DTBT: hazard ratio (HR) 1.00, 95% confidence interval (CI) 0.39-2.55, p=0.99] was not associated with all-cause death, a long DTBT (vs. intermediate DTBT: HR 2.80, 95% CI 1.26-6.17, p=0.011) was significantly associated with all-cause death, after controlling for confounding factors such as Killip class 4, an impaired renal function, and the number of diseased vessels. Conclusion The DTBT was significantly associated with the incidence of mid-term all-cause death. Our results support the strong adherence to the DTBT in patients with STEMI.

Comparison of door-to-balloon time and in-hospital outcomes in patients with ST-elevation myocardial infarction between before versus after COVID-19 pandemic

“…We investigated an onset time from our hospital records. In cases when the time of onset was described in ambiguous terms as just getting up, morning, noon, evening, bedtime, or mid-night in clinical records, those expressions were converted to specific times to calculate onset-to-balloon time as follows: Getting up as 6:00 am, morning as 9:00 am, noon as 12:00 pm, evening as 18:00 pm, bedtime as 21:00 pm, mid-night as 0:00 am [ 22 ]. We calculated onset-to-balloon time by 2 ways: (1) using all data as mentioned above and (2) using only the exact onset time, which excluded cases without the exact onset time.…”

“…We calculated onset-to-balloon time by 2 ways: (1) using all data as mentioned above and (2) using only the exact onset time, which excluded cases without the exact onset time. We defined a DTBT as the time from hospital arrival to the time of balloon dilation or thrombus aspiration [ 22 ].…”

“…We created two models in this analysis. In both models, we entered age [ 2 ], chronic renal failure on hemodialysis [ 2 ], Killip class 4 [ 2 ], left main-left anterior descending artery as the culprit lesion [ 22 ], triple vessel disease [ 6 ], and the use of mechanical support [ 16 ] as independent variables. In model 1, we also adopted chest CT before primary PCI as an independent variable, because chest CT before primary PCI was a must screening test in most patients in the post COVID-19 group.…”

Potential risk polarization for acute myocardial infarction during the COVID-19 pandemic: Single-center experiences in Osaka, Japan

“…Referred patients were reported to have a prolonged onset-to-door time because they came from a nearby clinic or were transferred from non-PCI-capable facilities. [14,19] Previous studies reported that the time interval from an AMI onset to ventricular septal perforation manifestation had a bimodal distribution; therefore, a longer ischemic time can become a risk factor for mechanical complications due to interactions with unknown factors. [10,22] In contrast, there was a significantly shorter door-to-balloon time in referred patients with STEMI after the pandemic declaration.…”

“…Onset-to-door time and door-to-balloon time were defined as the time from symptom onset to hospital arrival and from hospital arrival to balloon dilation or thrombus aspiration, respectively. [19] In the present study, renal dysfunction was defined as creatinine level >1.5 mg/dL. Left ventricular ejection fraction (LVEF) was assessed using echocardiography.…”