Publication Date
2012
Journal
The Texas Heart Journal
PMID
22719144
Publication Date(s)
2012
Language
English
PMCID
PMC3368457
PubMedCentral® Posted Date
2012
PubMedCentral® Full Text Version
Post-Print
Published Open-Access
yes
Keywords
Coronary angiography, door-to-balloon time, electrocardiography, emergency service, hospital/organization & administration/standards, emergency treatment, myocardial infarction, acute/therapy, myocardial reperfusion, percutaneous coronary intervention, practice guidelines as topic, retrospective studies, time factors, treatment outcome
Copyright
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Abstract
In patients with ST-elevation myocardial infarction, delay in door-to-balloon time strongly increases mortality rates. To our knowledge, no randomized studies to date have focused on reducing delays within the catheterization laboratory.
We performed a retrospective analysis of all patients who presented with ST-elevation myocardial infarction at our institution from July 2006 through June 2010, looking primarily at time differences between percutaneous coronary intervention in the culprit vessel on the basis of ECG criteria, followed by contralateral angiography (Group 1), versus complete coronary angiography followed by culprit-vessel percutaneous intervention (Group 2).
There were 49 patients in Group 1 and 57 patients in Group 2. No major differences in baseline characteristics were observed between the groups, except a higher prevalence of diabetes mellitus in Group 2. There was a statistically significant difference between Groups 1 and 2 in door-to-balloon time (median and interquartile range, 75 min [61–89] vs 87 min [70–115], P=0.03, respectively) and access-to-balloon time (12 min [9–18] vs 21 min [11–33], P=0.0006, respectively). Five Group 1 patients (10%) with inferior myocardial infarction had a contralateral culprit vessel. There were no differences in mortality rate or ejection fraction at the median 1-year follow-up. Four patients in Group 1 and 3 patients in Group 2 were referred for coronary artery bypass grafting after percutaneous intervention.
This study suggests that performing culprit-vessel percutaneous intervention on the basis of electrocardiographic criteria, followed by angiography in patients with anterior ST-elevation myocardial infarction, might be the preferred approach, given the door-to-balloon time that is saved.