Minimization of door‐to‐balloon time for ST‐elevation acute myocardial infarction: a case report

Akashi, Naoyuki; Sakakura, Kenichi; Yamamoto, Kei; Taniguchi, Yousuke; Wada, Hiroshi; Momomura, Shin‐ichi; Fujita, Hideo

doi:10.1002/ccr3.939

Cited by 4 publications

(2 citation statements)

References 21 publications

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“…Since a delayed DTBT was significantly associated with mid-term all-cause death in this study, efforts should be made to shorten the DTBT, as mentioned in recent guidelines ( 24 ). Furthermore, the catheter laboratory team might shorten the DTBT through their collaboration ( 25 ). Although our results showed the strong adherence to the DTBT in patients with STEMI, when STEMI patients present with Killip class 4, adequate respiratory support or mechanical circulatory support should be prioritized over the DTBT to achieve better clinical outcomes ( 26 - 29 ).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…According to the length of the whole hospitalization period, the study population was divided into the conventional hospitalization group (≤ 21 days) and the prolonged hospitalization group (> 21 days) [10]. Clinical characteristics were compared between the conventional and prolonged hospitalization groups, and multivariate logistic regression analysis was performed to find the determinants of prolonged hospitalization.…”

Section: Patientsmentioning

confidence: 99%

Determinants of prolonged hospitalization in patients who underwent trans-femoral transcatheter aortic valve implantation

Taniguchi

Sakakura

Yasuda

et al. 2019

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Introduction: Transcatheter aortic valve implantation (TAVI) has grown to be an alternative treatment for severe symptomatic aortic valve stenosis (AS) in elderly patients. Although TAVI is a less invasive surgery than surgical aortic valve replacement, some patients may require prolonged hospitalization. Aim: To find the determinants of prolonged hospitalization in patients who underwent trans-femoral TAVI. Material and methods: A total of 94 AS patients who underwent trans-femoral TAVI were included as the final study population, and divided into the conventional hospitalization group (≤ 21 days) (n = 74) and prolonged hospitalization group (> 21 days) (n = 20). We compared clinical characteristics between the two groups, and multivariate logistic regression analysis was performed to find the determinants of prolonged hospitalization. Results: In multivariate logistic regression analysis, moderate or severe mitral regurgitation (OR = 4.49, 95% CI: 1.16-17.47, p = 0.03), taking statins or angiotensin converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARB) on admission (statins: OR = 0.13, 95% CI: 0.02-0.71, p = 0.02, ACE inhibitors/ARB: OR = 0.25, 95% CI: 0.06-0.96, p = 0.04), estimated glomerular filtration rate (eGFR) (per 15 ml/min/1.73 m 2 incremental) (OR = 0.49, 95% CI: 0.26-0.90, p = 0.02) and current chopsticks user (OR = 0.05, 95% CI: 0.01-0.41, p < 0.01) were significantly associated with prolonged hospitalization. Conclusions: Moderate or severe mitral regurgitation was significantly associated with prolonged hospitalization, while current chopsticks user, eGFR (per 15 ml/min/1.73 m 2 incremental), taking ACE inhibitors/ARB or statins before the procedure were inversely associated with prolonged hospitalization in patients who underwent trans-femoral TAVI.

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Determinants of short and long door-to-balloon time in current primary percutaneous coronary interventions

et al. 2017

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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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Minimization of door‐to‐balloon time for ST‐elevation acute myocardial infarction: a case report

Cited by 4 publications

References 21 publications

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

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

Determinants of prolonged hospitalization in patients who underwent trans-femoral transcatheter aortic valve implantation

Determinants of short and long door-to-balloon time in current primary percutaneous coronary interventions

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