Barriers Associated With Door-to-Balloon Delay in Contemporary Japanese Practice

Background:Door-to-balloon (DTB) time ≤90 min is an important quality indicator in the management of ST-elevation myocardial infarction (STEMI), but a considerable number of patients still do not meet this goal, particularly in countries outside the USA and Europe.Methods and Results:We analyzed 2,4...

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Published in:Circulation Journal 2017/05/25, Vol.81(6), pp.815-822
Main Authors: Ikemura, Nobuhiro, Sawano, Mitsuaki, Shiraishi, Yasuyuki, Ueda, Ikuko, Miyata, Hiroaki, Numasawa, Yohei, Noma, Shigetaka, Suzuki, Masahiro, Momiyama, Yukihiko, Inohara, Taku, Hayashida, Kentaro, Yuasa, Shinsuke, Maekawa, Yuichiro, Fukuda, Keiichi, Kohsaka, Shun
Format: Article
Language:English
Subjects:
Acute coronary syndrome
Aged
Door-to-balloon time
Female
Hospitalization
Humans
Japan
Male
Middle Aged
Percutaneous Coronary Intervention
Registries
Reperfusion
ST Elevation Myocardial Infarction
ST-segment elevation myocardial infarction
Time Factors
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Summary:Background:Door-to-balloon (DTB) time ≤90 min is an important quality indicator in the management of ST-elevation myocardial infarction (STEMI), but a considerable number of patients still do not meet this goal, particularly in countries outside the USA and Europe.Methods and Results:We analyzed 2,428 STEMI patients who underwent primary PCI ≤12 h of symptom onset who were registered in an ongoing prospective multicenter database (JCD-KiCS registry), between 2008 and 2013. We analyzed both the time trend in DTB time within this cohort in the registry, and independent predictors of delayed DTB time >90 min. Median DTB time was 90 min (IQR, 68–115 min) during the study period and there were no significant changes with year. Predictors for delay in DTB time included peripheral artery disease, prior revascularization, off-hour arrival, age >75 years, heart failure at arrival, and use of IABP or VA-ECMO. Notably, high-volume PCI-capable institutions (PCI ≥200/year) were more adept at achieving shorter DTB time compared with low-volume institutions (PCI
ISSN:1346-9843
1347-4820
DOI:10.1253/circj.CJ-16-0905