Door-to-Balloon Time and Mortality among Patients Undergoing Primary PCI

Menees, Daniel S.; Peterson, Eric D.; Wang, Yongfei; Curtis, Jeptha P.; Messenger, John C.; Rumsfeld, John S.; Gurm, Hitinder S.

doi:10.1056/nejmoa1208200

Cited by 624 publications

(395 citation statements)

References 24 publications

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“…Meenes et al8 have shown that further reduction in D2B times have not resulted in decreased mortality in patients with STEMI. It appears that it is prudent to shift focus to prehospital care to investigate how C2D times can be shortened, which will improve survival.…”

Section: Discussionmentioning

confidence: 98%

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Impact of Sex and Contact‐to‐Device Time on Clinical Outcomes in Acute ST‐Segment Elevation Myocardial Infarction—Findings From the National Cardiovascular Data Registry

Roswell

Kunkes

Chen

et al. 2017

JAHA

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BackgroundEmergent myocardial reperfusion via primary percutaneous coronary intervention is optimal care for patients presenting with ST‐segment elevation myocardial infarction (STEMI). Delays in such interventions are associated with increases in mortality. With the shift in focus to contact‐to‐device (C2D) time as a new perfusion metric, this study was designed to examine how sex affects C2D time and mortality in STEMI patients.Methods and ResultsClinical data on male and female STEMI patients were extracted and analyzed from the National Cardiovascular Data Registry from July 1, 2008 to December 31, 2014. A total of 102 515 patients were included in the final analytic cohort. The median C2D time in female patients with STEMI was delayed when compared to male patients (80 [65–97] versus 75 [61–90] minutes; P<0.001). The unadjusted mortality was higher in female patients when compared to male patients with STEMI (4.1% versus 2.0%; P<0.001). For every 5‐minute increase in C2D time, the adjusted odds ratio for mortality was 1.04 (95% CI, 1.03–1.06) for female patients with STEMI and 1.07 (95% CI, 1.06–1.09) for male patients (P for sex by C2D interaction=0.003).ConclusionsTo date, this is the largest analysis of STEMI patients that measures the impact of the new recommended C2D reperfusion metric on in‐hospital mortality. Female STEMI patients have longer C2D times and increased mortality. The disparity can be improved and survival can increase in this high‐risk patient cohort by decreasing systems issues that cause increased reperfusion times in female STEMI patients.

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Section: Discussionmentioning

confidence: 98%

“…Studies have shown that reducing D2B times beyond this 90‐minute benchmark has not resulted in decreased mortality; notably, mortality from STEMI has plateaued with further reductions in D2B. Menees et al8 have demonstrated a 20% reduction in D2B times from 83 minutes in 2005, with no effect on mortality.…”

Section: Introductionmentioning

confidence: 99%

Impact of Sex and Contact‐to‐Device Time on Clinical Outcomes in Acute ST‐Segment Elevation Myocardial Infarction—Findings From the National Cardiovascular Data Registry

Roswell

Kunkes

Chen

et al. 2017

JAHA

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“…Current guidelines for the treatment of ST‐segment elevation myocardial infarction recommend a door‐to‐balloon time of 90 min or less for patients undergoing percutaneous coronary intervention;9, 10, 11 therefore, the shortening of the door‐to‐balloon time after introduction of JTAS is noteworthy.…”

Section: Discussionmentioning

confidence: 99%

“…So, it is important to assess how long the door‐to‐balloon time has shortened since the introduction of JTAS for patients with acute coronary syndrome, such as ST‐elevated myocardial infarction 9, 10, 11…”

Section: Introductionmentioning

confidence: 99%

A study of the effect of introduction of JTAS in the emergency room

Koyama

Kashima

Yamamoto

et al. 2017

Acute Medicine & Surgery

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AimThe purpose of this study was to better understand the effects of introducing the Japan Triage and Acuity Scale (JTAS) in the emergency room for walk‐in patients.MethodsA simple triage was used in Term A (from April 2006 to December 2010, 4 years and 9 months) and the JTAS was introduced in Term B (from January 2011 to September 2015, 4 years and 9 months). The number of patients who had a sudden turn for the worse after arrival in the emergency room and the time between attendance and emergency catheterization (TBAEC) due to acute coronary syndrome were reviewed.ResultsThere were 653 patients in Term A and 626 patients in Term B who were finally diagnosed as having serious causes. There was no significant difference in the frequency of a sudden turn for the worse between the two terms. There were 182 patients in Term A and 167 patients in Term B who underwent emergency catheterization due to acute coronary syndrome. When ST elevation was recognized in the first electrocardiogram, the median time between attendance and medical attention during Term B improved significantly, by 4.5 min. However, there was no significant difference in medians for TBAEC. When ST elevation was not recognized, there was no significant difference between the two terms, neither in terms of median time between attendance and medical attention, nor TBAEC.ConclusionThe data suggests that the effects of introducing the JTAS in the emergency room were restrictive in these two aspects.

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“…Recently, although the door‐to‐balloon time has improved significantly for patients undergoing primary percutaneous coronary intervention (PCI) for an acute myocardial infarction (AMI), the in‐hospital mortality has remained virtually unchanged 1. Implantable cardioverter defibrillators (ICDs) have been widely recognized as effective devices for preventing sudden cardiac death from fatal arrhythmias 2, 3.…”

Section: Introductionmentioning

confidence: 99%

Continuous ST‐Monitoring Function of Implantable Cardioverter Defibrillator Detects Silent Ischemia in Patients With Coronary Artery Disease

Watanabe¹,

Hirooka

Furukawa

et al. 2018

JAHA

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BackgroundNewer implantable cardioverter defibrillators can monitor intracardiac ECGs , but their ability to detect ischemia is unclear. This study investigated the usefulness of implantable cardioverter defibrillators with an ST‐monitoring function in coronary artery disease patients.Methods and ResultsWe conducted a prospective study of implantable cardioverter defibrillator patients with the ST‐monitoring function. One hundred seventy‐three patients who received implantable cardioverter defibrillators for primary or secondary prevention of sudden cardiac death. All patients underwent medical examinations at least every 6 months, with standard 12‐lead ECGs and device checks that included analysis of the ST‐monitoring function. Myocardial perfusion imaging or coronary angiography was performed during the follow‐up. The mean follow‐up duration was 23.3±7.7 months. Significant ST changes occurred in 15 patients (8.7%), of whom 14 were asymptomatic. The incidence of angina pectoris was significantly higher in the ST change (+) group than that in the ST change (−) group (28.6% versus 7.2%, P=0.03). In the patients who underwent myocardial perfusion imaging, the sensitivity, specificity, and negative predictive value of the ST‐monitoring feature to detect ischemia were 75.0%, 72.5%, and 93.5%, respectively. The sensitivity, specificity, and negative predictive value of the ST‐monitoring feature to predict residual stenosis evaluated using coronary angiography were 76.9%, 83.5%, and 97.5%, respectively. The percentage of patients with a septal right ventricular lead was significantly lower in the ST change (+) group than in the ST change (−) group (13.5% versus 33.5%, P=0.01).ConclusionsIf intracardiac ECGs ST changes are detected, it is necessary to use additional modalities even in asymptomatic patients.Clinical Trial RegistrationURL: http://upload.umin.ac.jp. Unique identifier: UMIN000011824.

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Door-to-Balloon Time and Mortality among Patients Undergoing Primary PCI

Cited by 624 publications

References 24 publications

Impact of Sex and Contact‐to‐Device Time on Clinical Outcomes in Acute ST‐Segment Elevation Myocardial Infarction—Findings From the National Cardiovascular Data Registry

Impact of Sex and Contact‐to‐Device Time on Clinical Outcomes in Acute ST‐Segment Elevation Myocardial Infarction—Findings From the National Cardiovascular Data Registry

A study of the effect of introduction of JTAS in the emergency room

Continuous ST‐Monitoring Function of Implantable Cardioverter Defibrillator Detects Silent Ischemia in Patients With Coronary Artery Disease

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