Association of onset to balloon and door to balloon time with long term clinical outcome in patients with ST elevation acute myocardial infarction having primary percutaneous coronary intervention: observational study

Shiomi, Hiroki; Nakagawa, Yoshihisa; Morimoto, Takeshi; Furukawa, Yutaka; Nakano, Akira; Shirai, Shinichi; Taniguchi, Ryoji; Yamaji, Kyohei; Nagao, Keisuke; Suyama, Tamaki; Mitsuoka, Hirokazu; Araki, Makoto; Takashima, Hiroyuki; Mizoguchi, Tetsu; Eisawa, Hiroshi; Sugiyama, Seigo; Kimura, Takeshi

doi:10.1136/bmj.e3257

Cited by 163 publications

(139 citation statements)

References 20 publications

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“…4 In contrast, the median DTB time in a multicenter registry conducted between January 2005 and December 2007 in Japan (CREDOKyoto) was 90 min (IQR, 60-132 min). 15 The present study has noted similar results in the more contemporary era of PCI, and highlights the need for progress in this area. Another study from a Japanese multicenter registry (J-AMI registry) noted a better result than the present one, in that median DTB time was 42 min (IQR, 28-66 min) for MayOctober 2011.…”

Section: Previous Studies and Implications For Dtb Time In Japansupporting

confidence: 72%

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Barriers Associated With Door-to-Balloon Delay in Contemporary Japanese Practice

Ikemura

Sawano

Ueda

et al. 2017

Circ J

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be required in non-Western countries, including Japan. Specifically, several studies have emphasized the volumeoutcome relationship in the assessment of DTB time, but this trend may differ in universal health care. 18 Japan implemented social health insurance in 1961, and, consequently, primary PCI is performed far more aggressively compared with Western countries. 16 Hence, to assess country-specific gaps and identify areas for improvement, the aim of this study was to evaluate the current status of STEMI care with regard to DTB time in Japan, and further explore predictors associated with delay in DTB time using a large-scale, multicenter PCI registry. Methods DataWe obtained data from the Japan Cardiovascular DatabaseKeio interhospital Cardiovascular Studies (JCD-KiCS) P rimary percutaneous coronary intervention (PCI) is a life-saving treatment for ST-segment elevation myocardial infarction (STEMI), 1-3 and, importantly over the last decade, shorter patient-specific door-toballoon (DTB) time, which is the time interval from arrival at hospital to inflation of the balloon to restore coronary flow, is consistently associated with lower long-term mortality. 4,5 Consequently, clinical guidelines recommend DTB time ≤90 min, 6,7 and this is considered a key indicator for providing high-quality care in the USA. 8, 9 Studies from large-scale databases have identified predictors and strategies to allow individual hospitals and larger health-care systems to decrease DTB time. 10-14Based on these findings, DTB time has been successfully reduced in Western countries. These implications from Western countries, however, may be limited, 15 because of significant differences in patient characteristics 16 and PCIcapable facilities, 17 and therefore different strategies may Background: Door-to-balloon (DTB) time ≤90 min is an important quality indicator in the management of ST-elevation myocardial infarction (STEMI), but a considerable number of patients still do not meet this goal, particularly in countries outside the USA and Europe.

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Section: Previous Studies and Implications For Dtb Time In Japansupporting

confidence: 72%

“…10- 14 Based on these findings, DTB time has been successfully reduced in Western countries. These implications from Western countries, however, may be limited, 15 because of significant differences in patient characteristics 16 and PCIcapable facilities, 17 and therefore different strategies may IKEMURA N et al…”

Section: Datamentioning

confidence: 99%

Barriers Associated With Door-to-Balloon Delay in Contemporary Japanese Practice

Ikemura

Sawano

Ueda

et al. 2017

Circ J

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“…[17][18][19] However, for the painless group, S2D and S2B times may not be the best indicators of outcomes. As we noted in our study that, although the S2D and S2B times of the painless STEMI group were shorter as compared to the group with pain, outcomes were poorer.…”

Section: Discussionmentioning

confidence: 99%

Reperfusion treatment delays amongst patients with painless ST segment elevation myocardial infarction

Pek

Loy

Wah

et al. 2016

CJEM

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Objective: Early reperfusion therapy in the treatment of ST segment elevation myocardial infarction (STEMI) patients can improve outcomes. Silent myocardial infarction is associated with poor prognosis, but little is known about its effect on treatment delays. We aimed to characterize STEMI patients presenting without complaints of pain to the emergency departments (EDs) in Singapore. Methods: Retrospective data were requested from the Singapore Myocardial Infarction Registry (SMIR), a national level registry in Singapore. Painless STEMI was defined as the absence of pain (chest, back, shoulder, jaw, and epigastric pain) during ED presentation. The primary outcome was door-to-balloon (D2B) time, defined as the earliest time a patient arrived in the ED to balloon inflation. Secondary outcomes were 1-month and 1-year mortality and occurrence of adverse events. Results: From January 2010 to December 2012, the SMIR collected 6412 cases; 10.9% of patients presented without any pain. These patients were older (median age = 75 v. 58 years old), more likely to be females (39.9% v. 16.1%), Chinese (74.9% v. 62.7%), obese (median body mass index [BMI] = 24.5 v. 22.1), and with history of hypertension (71.1% v. 54.6%), diabetes mellitus (48.6% v. 37.0%), and acute myocardial infarction (20.0% v. 12.3%). They had a longer median D2B (80.5 v. 63 minutes, p < 0.001) and a higher occurrence of 30-day (38.4% v. 5.7%) and 1-year mortality rates (47.3% v. 8.5%). Conclusion: A small proportion of STEMI patients presented without any pain to the ED. They tended to have a higher D2B and risks of mortality. Targeted effort is required to improve diagnostic and treatment efficiency in this group. RÉSUMÉContexte: La reperfusion précoce dans le traitement de l'infarctus du myocarde avec sus-décalage du segment ST (STEMI) peut améliorer les résultats cliniques. L'infarctus du myocarde silencieux est associé à un sombre pronostic, mais on en connaît peu sur l'incidence qu'il a sur les retards de traitement. L'étude visait donc à caractériser les patients qui souffraient d'un STEMI, sans ressentir de douleur thoracique, et qui ont consulté dans un service des urgences (SU), à Singapour. Méthode: Il y a eu une collecte de données rétrospectives, tirées du Singapore Myocardial Infarction Registry (SMIR), un registre national établi à Singapour. Le STEMI indolore a été défini comme l'absence de douleur (à la poitrine, dans le dos, à l'épaule, à la mâchoire ou à l'épigastre) durant le séjour au SU. Le principal critère d'évaluation était le temps écoulé depuis la première minute d'arrivée au SU jusqu'au gonflement du ballonnet. Les critères d'évaluation secondaires consistaient en la mortalité au bout de 1 mois et de 1 an et en la survenue d'événements indésirables.

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“…In STEMI treatment, this delay increased the total ischemia time which is an even more important predictor than D2B time of impaired myocardial reperfusion and mortality. 22,23) Public education of early hospital contact to minimize symptom onset-to-door time should be another important task to improve STEMI care in Taiwan. We also noted that more patients resuscitated from OHCA were sent in for primary PCI, which contributed significantly to the increased in-hospital mortality.…”

Section: Discussionmentioning

confidence: 99%

Analysis of the Clinical Characteristics, Management, and Causes of Death in Patients with ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention from 2005 to 2014

et al. 2016

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SummaryIt is unknown whether there has been any change in the causes of death for acute ST-segment elevation myocardial infarction (STEMI) in the era of aggressive reperfusion. We analyzed the direct causes of in-hospital death in patients with STEMI treated with primary percutaneous coronary intervention (PCI) in a tertiary referral center over the past 10 years.We retrospectively analyzed 878 STEMI patients treated with primary PCI in our hospital between January 2005 and December 2014. There were no significant changes in the age and sex of patients, but the prevalence of hypertension and smoking decreased. STEMI severity increased with more patients in Killip classification > 2. The number of out-ofhospital cardiac arrest events also increased over the 10 years. Symptom onset-to-door time did not change in the 10-year study period. The care quality was improved with shorter door-to-balloon time for primary PCI and increased use of dual antiplatelet therapy. The all-cause in-hospital mortality was 9.1%, which did not vary over the 10 years. Multivariable analysis showed that Killip classification > 2 was the most important determinant of death. Cardiogenic shock was the major cause of cardiovascular death. There was an increase in non-cardiovascular causes of death in the most recent 3 years, with infection being a major problem.Despite improvement in care quality for STEMI, the in-hospital mortality did not decrease in this tertiary referral center over these 10 years due to increased disease severity and non-cardiovascular causes of death. (Int Heart J 2016; 57: 541-546) Key words: Acute myocardial infarction, Coronary angioplasty, Mortality A cute myocardial infarction is an important public health issue in Taiwan because it carries a high fatality rate and its incidence is still increasing. 1) In acute ST-segment elevation myocardial infarction (STEMI), timely primary percutaneous coronary intervention (PCI) and the use of evidence-based medications significantly decrease mortality, and are strongly recommended in local 2) and international guidelines.3,4) In Taiwan, more than 95% of STEMI patients received primary PCI as the initial reperfusion therapy, and the door-to-balloon (D2B) time has improved. 5,6) A previous observational study demonstrated that early primary PCI could decrease the incidence of cardiogenic shock, which is the major cause of death in STEMI.7) It is unknown whether there has been any temporal change in the causes of death during hospitalization for STEMI with the advent of aggressive reperfusion in recent years. Information on the specific causes of death can reveal the weak points of current treatment and enable the implementation of new strategies to improve the quality of care for STEMI patients treated with primary PCI. The major aims of the present study were to describe the 10-year secular trends in the clinical characteristics and management of STEMI patients treated with primary PCI, and to specifically analyze the causes of death in these patients in a tertiary referral c...

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Association of onset to balloon and door to balloon time with long term clinical outcome in patients with ST elevation acute myocardial infarction having primary percutaneous coronary intervention: observational study

Cited by 163 publications

References 20 publications

Barriers Associated With Door-to-Balloon Delay in Contemporary Japanese Practice

Barriers Associated With Door-to-Balloon Delay in Contemporary Japanese Practice

Reperfusion treatment delays amongst patients with painless ST segment elevation myocardial infarction

Analysis of the Clinical Characteristics, Management, and Causes of Death in Patients with ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention from 2005 to 2014

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