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ABS20191115_0021
| Acute Coronary Syndromes (STEMI, NSTE-ACS) | |
| Is Door to Balloon(D2B) Time Still Important in ST Elevation Myocardial Infarction (STEMI) Patients? | |
| Moo Hyun Kim1, Kwang-Min Lee2, XUAN JIN1 | |
| Dong-A University Hospital, Korea (Republic of)1, Dong-A University Medical Center, Korea (Republic of)2 | |
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Background:
Guidelines for the treatment of ST-segment elevation myocardial infarction recommend a door-to-balloon time of 90 minutes or less for patients undergoing primary percutaneous coronary intervention (PCI). However, it is not well known whether there are further differences present within D2B time < 90 minutes
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Methods:
From the Korean Registry of Regional Cardiocerebrovascular Center for Acute Myocardial Infarction (July 2016 - Sept 2018), patients over 18 years old who were performed primary PCI in STEMI patients were selected. We compared in-hospital event (all-cause death, cardiac arrest, CVA, bleeding) according to D2B time <60, 60~90, >90 minutes. We also calculated the receiver operator characteristic (ROC) curve for door to balloon time in the prediction of In-hospital event and defined the optimal cut-point value.
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Results:
In terms of the in-hospital death rate according to D2B, the in-hospital death rate of D2B has increased significantly from 30 minutes or more. The AUC values for in-hospital event were 0.619, respectively. Optimal cutoff scores of in-hospital evet were 59, respectively (fig A, B). Therefore, we defined the cut-point for D2B time as <60min, 60~<90min, ¡Ã 90min. Compared to D2B time<60min, 60min ¡Â D2B time <90min, D2B time¡Ã60 minutes was associated with increased risk of mortality (4.1% vs. 8.7% vs. 18.6%; p<0.001), cardiac arrest (5.8% vs. 11.0% vs. 20.2; p<0.001), CVA (0.4% vs. 1.1% vs. 4.7; p=0.002). As a result of logistic regression analysis, in-hospital death of D2B time 90 min was 3.6 times higher than D2B 60 min(OR: 3.639, 95% CI: 2.014 - 6.577), and arrest of D2B time 90 min was 2.9 times higher(OR: 2.955, 95% CI: 1.693 - 5.158) and CVA of D2B time 90 min was 12.0 times higher(OR: 12.041, 95% CI: 4.030 - 35.979) than 60 minutes(Table 1).
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Conclusion:
In patients who had ST-segment Elevation Myocardial Infarction, the balloon time <60 minutes is associated with favorable outcomes. These data suggest that additional strategies are needed to reduce in-hospital mortality in this population.
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