Effect on Door-to-Balloon Time of Immediate Transradial Percutaneous Coronary Intervention on Culprit Lesion in ST-Elevation Myocardial Infarction Compared to Diagnostic Angiography Followed by Primary Percutaneous Coronary Intervention
| Autor: | Olivier Costerousse, Guillaume Plourde, Ugo Déry, Eric Larose, Gérald Barbeau, Jean-Pierre Déry, Louis Roy, Olivier F. Bertrand, Jimmy MacHaalany, Robert De Larochellière, Eltigani Abdelaal, Onil Gleeton, Yoann Bataille |
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| Rok vydání: | 2013 |
| Předmět: |
Male
medicine.medical_specialty Time Factors medicine.medical_treatment Myocardial Infarction Coronary Angiography Culprit Statistics Nonparametric Electrocardiography Percutaneous Coronary Intervention Diagnostic angiography St elevation myocardial infarction Culprit lesion Internal medicine medicine Humans cardiovascular diseases Myocardial infarction Angioplasty Balloon Coronary Retrospective Studies business.industry Percutaneous coronary intervention Middle Aged medicine.disease Logistic Models Treatment Outcome surgical procedures operative Fluoroscopy Conventional PCI Door-to-balloon Cardiology Female Radiology Cardiology and Cardiovascular Medicine business therapeutics |
| Zdroj: | The American Journal of Cardiology. 111:836-840 |
| ISSN: | 0002-9149 |
| Popis: | Door-to-balloon (DTB) time is an important metric in primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction to optimize clinical outcomes. The aim of this study was to compare the impact of immediate PCI on culprit lesions in patients with ST-segment elevation myocardial infarctions versus diagnostic angiography followed by PCI on DTB times and procedural data at a high-volume tertiary care radial center. All patients who underwent primary PCI12 hours after symptom onset were studied. Procedural data and all-cause mortality were assessed in all patients. The primary outcome was DTB time. From January 2006 to June 2011, 1,900 patients were included and divided into 2 groups: 562 patients (30%) underwent primary PCI followed by contralateral diagnostic angiography, and 1,338 patients (70%) underwent diagnostic angiography before primary PCI. No significant differences were observed in baseline characteristics. Left anterior descending coronary artery-related ST-segment elevation myocardial infarctions were more often found in patients who underwent PCI first (54% vs 34%, p0.0001). Overall, there was a reduction of 8 minutes in DTB time between patients who underwent PCI first and those who underwent angiography first (32 minutes [interquartile range 24 to 52] vs 40 minutes [interquartile range 30 to 69], respectively, p0.0001). After adjustment, immediate PCI remained an independent predictor of DTB time ≤90 minutes (odds ratio 2.42, 95% confidence interval 1.70 to 3.52, p0.0001). There were no differences in early and late clinical outcomes. In conclusion, a strategy of transradial direct PCI of the infarct-related artery in selected patients before complete coronary angiography was associated with a benefit of 8 minutes in DTB time. Further study is required to determine whether this strategy can favorably affect clinical outcomes. |
| Databáze: | OpenAIRE |
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