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Determinants of short and long door-to-balloon time in current primary percutaneous coronary interventions

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Abstract

Primary percutaneous coronary interventions (PCI) have been developed to improve clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). In primary PCI, the door-to-balloon time (DTBT) is closely associated with mortality and morbidity. The purpose of this study was to find determinants of short and long DTBT. From our hospital record, we included 214 STEMI patients, and divided into the short DTBT group (DTBT < 60 min, n = 60), the intermediate DTBT group (60 min ≤ DTBT ≤ 120 min, n = 121) and the long DTBT group (DTBT > 120 min, n = 33). In-hospital mortality was highest in the long DTBT group (24.2%), followed by the intermediate DTBT group (5.8%), and lowest in the short DTBT group (0%) (< 0.001). Transfers from local clinics or hospitals (OR 3.43, 95% CI 1.72–6.83, P < 0.001) were significantly associated with short DTBT, whereas Killip class 3 or 4 (vs. Killip class 1 or 2: OR 0.20, 95% CI 0.06–0.64, P = 0.007) was inversely associated with short DTBT in multivariate analysis. In conclusion, transfer from local clinics/hospitals was associated with short DTBT. Our results may suggest the current limitation of ambulance system, which does not include pre-hospital ECG system, in Japan. The development of pre-hospital ECG system would be needed for better management in STEMI.

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Acknowledgements

The authors acknowledge all staff in the catheter laboratory in Saitama Medical Center, Jichi Medical University, for their technical support in this study.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan

    Takunori Tsukui, Kenichi Sakakura, Yousuke Taniguchi, Kei Yamamoto, Hiroshi Wada, Shin-ichi Momomura & Hideo Fujita

  2. Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan

    Kenichi Sakakura

Authors
  1. Takunori Tsukui
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  2. Kenichi Sakakura
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  3. Yousuke Taniguchi
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  6. Shin-ichi Momomura
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Correspondence to Kenichi Sakakura.

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Conflict of interest

Dr. Sakakura has received speaking honoraria from Abbott Vascular, Boston Scientific, Medtronic Cardiovascular, Terumo, OrbusNeich, Daiichi-Sankyo, Sanofi, and NIPRO; has served as a proctor for Rotablator for Boston Scientific; and has served as a consultant for Abbott Vascular and Boston Scientific. Prof. Fujita served as a consultant for Mehergen Group Holdings, Inc.

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Tsukui, T., Sakakura, K., Taniguchi, Y. et al. Determinants of short and long door-to-balloon time in current primary percutaneous coronary interventions. Heart Vessels 33, 498–506 (2018). https://doi.org/10.1007/s00380-017-1089-x

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