Door-to-device time and mortality in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention: insight from real world data of Thai PCI Registry.

IF 2.1 3区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiovascular diagnosis and therapy Pub Date : 2023-10-31 Epub Date: 2023-10-08 DOI:10.21037/cdt-22-611
Kitcha Champasri, Suphot Srimahachota, Mann Chandavimol, Wasan Udayachalerm, Ammarin Thakkinstian, Bancha Sookananchai, Wannakorn Phatharajaree, Songsak Kiatchoosakun, Nakarin Sansanayudh
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Abstract

Background: Timely reperfusion therapy is recommended for patients with ST-segment elevation myocardial infarction (STEMI), and system delay <90 minutes and door-to-device (D2D) time <60 minutes are recommended by the 2017 ESC Guidelines for the management of STEMI patients and have been proposed as a performance measure for triaging patients for primary percutaneous coronary intervention (PCI). However, previous research produced contradictory results regarding the association between D2D time and mortality. Therefore, this study aimed to examine the associations between D2D time and mortality in Thailand.

Methods: This cohort study included STEMI patients treated with primary PCI in 39 PCI centres in Thailand from February 27, 2018, to August 1, 2019. Patients were eligible if they met the following criteria: primary STEMI diagnosis, symptom onset within 12 hours, and ST-segment elevation of at least 0.1 mV in 2 or more contiguous leads (at least 0.2 mV in V1-V3) or a new left bundle branch block.

Results: Within 12 hours of symptom onset, 3,874 patients underwent primary PCI. The median D2D time was 54 minutes [interquartile range (IQR) 29-90], and there was a significant difference between patients transferred from other hospitals (44 minutes, IQR 25-77, n=2,871) and patients presented directly to PCI centres (81 minutes, IQR 56-129, n=1,003) (P<0.001). Overall, in-hospital mortality was 7.8%. In a multivariable analysis, adjusting for other predictors of mortality and stratifying according to intervals of D2D time, cumulative in-hospital mortality was significantly higher in patients with a D2D time greater than 90 minutes [hazard ratio (HR) 1.5, 95% confidence interval (CI): 1.0-2.1, P=0.046] but not associated with D2D time shorter than 60 minutes (HR 1.2, 95% CI: 0.8-1.8, P=0.319).

Conclusions: A D2D time greater than 90 minutes was related to in-hospital mortality in patients with STEMI treated with primary PCI, but a D2D time less than 60 minutes was not consistently associated with D2D time-improved survival in real-world, contemporary practice in Thailand.

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直接经皮冠状动脉介入治疗ST段抬高型心肌梗死患者的门到设备时间和死亡率:来自泰国PCI注册中心真实世界数据的见解。
背景:建议ST段抬高型心肌梗死(STEMI)和系统延迟患者及时再灌注治疗方法:该队列研究包括2018年2月27日至2019年8月1日在泰国39个PCI中心接受原发PCI治疗的STEMI患者。如果患者符合以下标准,则符合条件:初次STEMI诊断、12小时内症状发作、2个或更多连续导联ST段抬高至少0.1 mV(V1-V3至少0.2 mV)或新的左束支传导阻滞。结果:在症状出现的12小时内,3874名患者接受了初次PCI。D2D时间中位数为54分钟[四分位间距(IQR)29-90],从其他医院转诊的患者(44分钟,IQR 25-77,n=2871)和直接到PCI中心就诊的患者(81分钟,IQR56-129,n=1003)之间存在显著差异(结论:D2D时间大于90分钟与经皮冠状动脉介入治疗的STEMI患者的住院死亡率有关,但在泰国现实世界的当代实践中,D2D时间小于60分钟与D2D时间提高生存率并不一致。
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来源期刊
Cardiovascular diagnosis and therapy
Cardiovascular diagnosis and therapy Medicine-Cardiology and Cardiovascular Medicine
CiteScore
4.90
自引率
4.20%
发文量
45
期刊介绍: The journal ''Cardiovascular Diagnosis and Therapy'' (Print ISSN: 2223-3652; Online ISSN: 2223-3660) accepts basic and clinical science submissions related to Cardiovascular Medicine and Surgery. The mission of the journal is the rapid exchange of scientific information between clinicians and scientists worldwide. To reach this goal, the journal will focus on novel media, using a web-based, digital format in addition to traditional print-version. This includes on-line submission, review, publication, and distribution. The digital format will also allow submission of extensive supporting visual material, both images and video. The website www.thecdt.org will serve as the central hub and also allow posting of comments and on-line discussion. The web-site of the journal will be linked to a number of international web-sites (e.g. www.dxy.cn), which will significantly expand the distribution of its contents.
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