Optimal door-to-balloon time for primary percutaneous coronary intervention for ST-elevation myocardial infarction.

Autor: Koh SJQ; National Heart Centre Singapore, Cardiology, Singapore., Jiang Y; National Heart Centre Singapore, Cardiology, Singapore., Lau YH; National Heart Centre Singapore, Cardiology, Singapore., Yip WLJ; National University Heart Centre Singapore, Cardiology, Singapore., Chow WE; Changi General Hospital, Cardiology, Singapore., Chia PL; Tan Tock Seng Hospital, Cardiology, Singapore., Loh PH; Ng Teng Fong General Hospital, Cardiology, Singapore., Chong TTD; National Heart Centre Singapore, Cardiology, Singapore; Sengkang General Hospital, Cardiology, Singapore., Lim ZYP; Khoo Teck Puat Hospital, Cardiology, Singapore., Tan WCJ; National Heart Centre Singapore, Cardiology, Singapore., Wong SLA; National Heart Centre Singapore, Cardiology, Singapore., Yeo KK; National Heart Centre Singapore, Cardiology, Singapore; Duke-NUS Medical School, Singapore., Yap J; National Heart Centre Singapore, Cardiology, Singapore; Duke-NUS Medical School, Singapore. Electronic address: jonyap@yahoo.com.
Jazyk: angličtina
Zdroj: International journal of cardiology [Int J Cardiol] 2024 Oct 15; Vol. 413, pp. 132345. Date of Electronic Publication: 2024 Jul 10.
DOI: 10.1016/j.ijcard.2024.132345
Abstrakt: Background: Door-to-balloon time (DTBT) for ST-elevation myocardial infarction (STEMI) is a performance metric by which primary percutaneous coronary intervention (PPCI) services are assessed.
Methods: Consecutive patients presenting with STEMI undergoing PPCI between January 2007 to December 2019 from the Singapore Myocardial Infarction Registry were included. Patients were stratified based on DTBT (≤60 min, 61-90 min, 91-180 min) and Killip status (I-III vs. IV). Outcomes assessed included all-cause mortality and major adverse cardiovascular events (MACE) at 30-days and 1-year.
Results: In total, 13,823 patients were included, with 82.59% achieving DTBT ≤90 min and 49.77% achieving DTBT ≤60 min. For Killip I-III (n = 11,591,83.85%), the median DTBT was 60[46-78]min. The 30-day all-cause mortality for DTBT of ≤60 min, 61-90 min and 91-180 min was 1.08%, 2.17% and 4.33% respectively (p < 0.001). On multivariate analysis, however, there was no significant difference for 30-day and 1-year outcomes across all DTBT (p > 0.05). For Killip IV, the median DTBT was 68[51-91]min. The 30-day all-cause mortality for DTBT of ≤60 min, 61-90 min and 91-180 min was 11.74%, 20.48% and 35.06% respectively (p < 0.001). On multivariate analysis for 30-day and 1-year outcomes, DTBT 91-180 min was an independent predictor of worse outcomes (p < 0.05), but there was no significant difference between DTBT of ≤60 min and 61-90 min (p > 0.05).
Conclusion: In Killip I-III patients, DTBT had no significant impact on outcomes upon adjustment for confounders. Conversely, for Killip IV patients, a DTBT of >90 min was associated with significantly higher adverse outcomes, with no differences between a DTBT of ≤60 min vs. 61-90 min. Outcomes in STEMI involve a complex interplay of factors and recommendations of a lowered DTBT of ≤60 min will require further evaluation.
(Copyright © 2023. Published by Elsevier B.V.)
Databáze: MEDLINE
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