Relationship of Symptom-Onset-to-Balloon Time and Door-to-Balloon Time With Mortality in Patients Undergoing Angioplasty for Acute Myocardial Infarction

Cp, Cannon; Gibson, C. Michael; Ct, Lambrew; Da, Shoultz; Levy, Denis; Wj, French; Gore, JM; Weaver, W. Douglas; Wj, Rogers; Aj, Tiefenbrunn

doi:10.1001/jama.283.22.2941

Cited by 1,086 publications

(635 citation statements)

References 50 publications

Supporting

Mentioning

571

Contrasting

Unclassified

Order By: Relevance

“…Additional meta-analysis data suggest that major adverse cardiac events increase with prolonged time to hospital presentation in patients receiving fibrinolysis, but that prolonged STB times minimally influence infarct artery patency or survival outcomes following primary PCI. 6 The above data have focused most primary PCI quality improvement efforts toward reducing DTB times. 22,23 Still, other studies have highlighted the importance of STB times on STEMI outcomes.…”

Section: Primary Pci Delays and Mortalitymentioning

confidence: 99%

“…3,5 Despite this recommendation, achieving primary PCI within 90 minutes has proven to be an elusive goalespecially for patients presenting to hospitals without PCI capability. Although some studies have suggested that time to reperfusion is less important for PCI than fibrinolysis, 6,7 most studies have demonstrated that treatment delays to primary PCI are associated with increased mortality 8 -13 and larger infarct size. 14 Prior studies, however, differ on whether the total ischemic interval between symptom onset and PCI reperfusion, so-called symptom-to-balloon (STB) time best predicts mortality, or whether mortality is more strongly determined by the duration between hospital arrival and performance of primary angioplasty, the so-called door-toballoon (DTB) time.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Mortality Implications of Primary Percutaneous Coronary Intervention Treatment Delays: Insights From the Assessment of Pexelizumab in Acute Myocardial Infarction Trial

Hudson

Armstrong

O'Neil

et al. 2011

Circ: Cardiovascular Quality and Outcomes

View full text Add to dashboard Cite

Background-Prior studies demonstrate a direct relationship between treatment delays to primary percutaneous intervention and mortality in patients with ST-segment elevation myocardial infarction (STEMI). This analysis compared the relationship of symptom onset-to-balloon time and door-to-balloon time on mortality in patients with STEMI. Methods and Results-We analyzed different treatment delays (symptom onset-to-balloon time, door-to-balloon time) and mortality in 5745 STEMI patients. Baseline characteristics, flow grade, 90-day mortality, and clinical outcomes were compared in patients stratified by treatment delay. Multivariable logistic regression modeling was performed to assess the independent and relative effect of each treatment delay on 90-day mortality. Female sex, increased age, and worse thrombolysis in myocardial infarction flow grade were significantly associated with longer symptom onset-to-balloon times and door-to-balloon times. Longer symptom onset-to-balloon time was significantly associated with worse 90-day mortality (3.7%, 4.2%, and 6.5% for time delays Ͻ3 hours, 3 to 5 hours, and Ͼ5 hours, respectively, PϽ0.0001).Similarly, longer door-to-balloon times were significantly associated with worse 90-day mortality (3.2%, 4.0%, 4.6%, and 5.3% for delays Ͻ60 minutes, 60 to 90 minutes, 90 to 120 minutes, and Ն120 minutes respectively, PϽ0.0001). In a multivariate model of 90-day mortality, door-to-balloon time ( 2 6.0, PϽ0.014), and symptom onset-to-hospital arrival ( 2 9.8, PϽ0.007) remained independent determinants. Conclusions-Both

show abstract

Section: Primary Pci Delays and Mortalitymentioning

confidence: 99%

mentioning

confidence: 99%

Mortality Implications of Primary Percutaneous Coronary Intervention Treatment Delays: Insights From the Assessment of Pexelizumab in Acute Myocardial Infarction Trial

Hudson

Armstrong

O'Neil

et al. 2011

Circ: Cardiovascular Quality and Outcomes

View full text Add to dashboard Cite

show abstract

“…Timely response and early PCI during the “golden hour” (60 minutes) has been shown to decrease morbidity and mortality associated with AMI 4, 5, 6. Driving time to a PCI‐capable hospital is an important factor in the timely response to this life‐saving intervention 5, 7. A study by Nallamothu and colleagues found that nearly 80% of the US population lived within 60 minutes to a PCI‐capable hospital with a median driving time of 11.3 minutes 8.…”

Section: Introductionmentioning

confidence: 99%

Neighborhood and Acute Myocardial Infarction Mortality as Related to the Driving Time to Percutaneous Coronary Intervention–Capable Hospital

Balamurugan

Delongchamp

et al. 2016

JAHA

View full text Add to dashboard Cite

BackgroundDriving time to a percutaneous coronary intervention (PCI)–capable hospital is important in timely treatment of acute myocardial infarction (AMI). Our objective was to determine whether driving time from one's residence to a PCI‐capable hospital contributes to AMI deaths. We conducted a cross‐sectional study of age‐ and sex‐adjusted mortality in census block groups to evaluate this question.Methods and ResultsWe studied all (14 027) AMI deaths that occurred during 2008–2012 in Arkansas to assess the relationship between driving time from the population center of a block group (neighborhood) to the nearest PCI‐capable hospital. We estimated standardized mortality ratios in block groups that were adjusted for education (population over 25 years of age who did not graduate from high school), poverty (population living below federal poverty level), population density (population per square mile), mobility (population residing at the same address as 1 year ago), black (population that is black), rurality (rural households), geodesic distance, and driving time. The median geodesic distance and driving time were 12.8 miles (interquartile range 3.6–30.1) and 28.3 minutes (interquartile range 9.6–58.7), respectively. Risks in neighborhoods with long driving times (90th percentile) were 26% greater than risks in neighborhoods with short driving times (10th percentile), even after adjusting for education, poverty, population density, rurality, and black race (P<0.0001).Conclusions AMI mortality increases with increasing driving time to the nearest PCI‐capable hospital. Improving the healthcare system by reducing time to arrive at a PCI‐capable hospital could reduce AMI deaths.

show abstract

“…Shorter doorto-balloon (D2B) time has strong association with a lower mortality rate [3][4][5]. Based on these data, a D2B time of \90 min has been established as a Class I recommendation in the current guidelines [6,7].…”

Section: Introductionmentioning

confidence: 99%

Impact of a single universal guiding catheter on door-to-balloon time in primary transradial coronary intervention for ST segment elevation myocardial infarction

Torii

Fujii

Murakami

et al. 2016

Cardiovasc Interv and Ther

View full text Add to dashboard Cite

The purpose of this study is to determine reduction of door-to-balloon (D2B) time using a single universal guiding catheter (Ikari-Left catheter) in transradial approach. In this procedure, we can skip a total of five steps compared with a conventional procedure (two catheter insertions, two catheter removals, and one catheter engagement). Reducing total ischemic time is important to achieving a better outcome in primary percutaneous coronary intervention (PCI) for ST segment elevation myocardial infarction (STEMI). We retrospectively compared 30 consecutive STEMI patients who underwent transradial primary PCI with a single guiding catheter (IL group) with 30 consecutive patients with conventional transradial primary PCI. Patients with cardiogenic shock, heart failure, or need for intra-aortic balloon pumping support before primary PCI were excluded. Baseline characteristics were not different between the two groups. The D2B time was significantly shorter in the IL group (55 ± 16 vs. 63 ± 17 min, respectively; p = 0.01). Puncture-to-balloon time was also significantly shorter in the IL group (15 ± 11 min vs. 25 ± 11 min, respectively; p = 0.001). The total number of diagnostic and guiding catheters was significantly less in IL group (1 (IQR 1-1) vs. 3 (IQR 3-3), respectively; p \ 0.0001). Primary PCI with a single universal guiding catheter reduced D2B time by skipping several procedural steps, and reduced the total number of catheters needed. This technique could reduce patient mortality as well as total medical cost.

show abstract

Relationship of Symptom-Onset-to-Balloon Time and Door-to-Balloon Time With Mortality in Patients Undergoing Angioplasty for Acute Myocardial Infarction

Cited by 1,086 publications

References 50 publications

Mortality Implications of Primary Percutaneous Coronary Intervention Treatment Delays: Insights From the Assessment of Pexelizumab in Acute Myocardial Infarction Trial

Mortality Implications of Primary Percutaneous Coronary Intervention Treatment Delays: Insights From the Assessment of Pexelizumab in Acute Myocardial Infarction Trial

Neighborhood and Acute Myocardial Infarction Mortality as Related to the Driving Time to Percutaneous Coronary Intervention–Capable Hospital

Impact of a single universal guiding catheter on door-to-balloon time in primary transradial coronary intervention for ST segment elevation myocardial infarction

Contact Info

Product

Resources

About