Document Detail

Minimizing Door-to-Balloon Time Is not the Most Critical Factor in Improving Clinical Outcome of ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention.
MedLine Citation:
PMID:  24717469     Owner:  NLM     Status:  Publisher    
OBJECTIVES:: We tested the hypothesis that, as compared with conventional door-to-balloon, shortened door-to-balloon time would further improve 30-day outcome in ST-elevation myocardial infarction (STEMI) patients undergoing primary stenting.
DESIGN:: Retrospective cohort study SETTING:: Academic tertiary care hospital with approximately 2600 beds PATIENTS:: Between January 2008 and December 2009, 266 ST-elevation myocardial infarction patients underwent primary stenting with conventional Door-to-baloon were consecutively enrolled as group 1, while 293 ST-elevation myocardial infarction patients underwent primary stenting with shortened door-to-balloon between January 2010 and December 2011 were consecutively enrolled as group 2.
INTERVENTION:: Shorten door-to-balloon time.
MEASUREMENTS AND MAIN RESULTS:: The results showed that time from chest pain onset to door did not differ between two groups (p > 0.1), whereas door-to-balloon time was significantly reduced in group 2 compared with that in group 1 (p < 0.0001). The prevalences of successful reperfusion, acute and subacute stent thrombosis, 30-day death or combined endpoint (defined as congestive heart failure ≥ New York Heart Association functional class 3 or 30-d death), and left ventricular function did not differ between two groups (all p > 0.05), whereas the peak creatine phosphokinase level was significantly reduced in group 2 (< 0.05). Further analysis showed that shortening the chest pain-to-reperfusion time to less than 240 minutes was the most important factor in improving left ventricular function (p < 0.001) and 30-day combined endpoint. Multivariate analysis showed that congestive heart failure greater than or equal to New York Heart Association functional class 3, poor left ventricular function, and age (all p < 0.001) along with unsuccessful reperfusion (p = 0.25) were independently predictive of 30-day mortality.
CONCLUSION:: Shortening the duration between chest pain onset and reperfusion to less than 4.0 hours was critical in reducing myocardial necrosis and improving heart function and 30-day mortality.
Yuan-Chih Ho; Tzu-Hsien Tsai; Pei-Hsun Sung; Yung-Lung Chen; Sheng-Ying Chung; Cheng-Hsu Yang; Shyh-Ming Chen; Chien-Jen Chen; Hsiu-Yu Fang; Chiung-Jen Wu; Hon-Kan Yip
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-4-8
Journal Detail:
Title:  Critical care medicine     Volume:  -     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2014 Apr 
Date Detail:
Created Date:  2014-4-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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