Impact of Door-To-Balloon Time on Long-Term Mortality after Primary PCI
DOI:
https://doi.org/10.70749/ijbr.v2i02.224Keywords:
STEMI, Door-To-Balloon Time, Primary PCI, Mortality, Major Adverse Cardiovascular EventsAbstract
Objective: To evaluate the impact of door-to-balloon (D2B) time on long-term mortality and adverse outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) at Hayatabad Medical Complex, Peshawar.
Methodology: A prospective observational study was conducted from January 2022 to December 2022, including 320 STEMI patients. Patients were categorized into two groups based on D2B times: <90 minutes and ≥90 minutes. Data on demographics, symptom-to-door times, D2B times, and outcomes (mortality and major adverse cardiovascular events (MACE)) were collected. Statistical analysis was performed using appropriate tests, with a significance level of p<0.05.
Results: The mean symptom-to-door time was 145.6 minutes, and the mean D2B time was 96.7 minutes. Patients treated within <90 minutes of D2B time had a survival rate of 91.3% compared to 73.4% in the ≥90-minute group (p<0.05). MACE occurred in 12.5% of patients, with a higher prevalence in those with delayed D2B times. Male patients constituted 62.5% of the cohort, and the mean age was 54.3 years.
Conclusion: Shorter D2B times significantly improve survival and reduce adverse outcomes in STEMI patients. Adhering to the recommended <90 minutes for D2B is essential for optimizing clinical outcomes. Systemic changes to reduce delays are imperative for improving STEMI care.
References
Zahler D, Lee-Rozenfeld K, Ravid D, Rozenbaum Z, Banai S, Keren G, et al. Relation of lowering door-to-balloon time and mortality in ST segment elevation myocardial infarction patients undergoing percutaneous coronary intervention. Clin Res Cardiol 2019;108:1053–8. https://doi.org/10.1007/s00392-019-01438-6.
Bessonov IS, Sapozhnikov SS, Shadrin AA, Kashtanov MG, Popov S V. Effect of the “door-to-balloon” time on the results of treatment of patients with ST-segment elevation myocardial infarction, depending on the duration of the pre-hospital delay. Kardiologiia 2023;63:28–36. https://doi.org/10.18087/cardio.2023.6.n2245.
Murphy AC, Yudi MB, Farouque O, Dinh D, Duffy SJ, Brennan A, et al. Impact of Gender and Door-to-Balloon Times on Long-Term Mortality in Patients Presenting With ST-Elevation Myocardial Infarction. Am J Cardiol 2019;124:833–41. https://doi.org/10.1016/j.amjcard.2019.06.008.
Stehli J, Martin C, Brennan A, Dinh DT, Lefkovits J, Zaman S. Sex Differences Persist in Time to Presentation, Revascularization, and Mortality in Myocardial Infarction Treated With Percutaneous Coronary Intervention. J Am Heart Assoc 2019;8. https://doi.org/10.1161/JAHA.119.012161.
Mansoor B, . O, Iqbal M, Ali A, Malik F, Buzdar AW, et al. Efficacy of Primary Percutaneous Coronary Intervention (PCI) Performed Through a Transradial Approach in Patients with ST- Segment Elevation Myocardial Infarction (STEMI) at a Tertiary Care Cardiac Center. Pakistan J Med Heal Sci 2023;17:498–502. https://doi.org/10.53350/pjmhs2023174498.
Huded CP, Kumar A, Johnson M, Abdallah M, Ballout JA, Kravitz K, et al. Incremental Prognostic Value of Guideline-Directed Medical Therapy, Transradial Access, and Door-to-Balloon Time on Outcomes in ST-Segment–Elevation Myocardial Infarction. Circ Cardiovasc Interv 2019;12. https://doi.org/10.1161/CIRCINTERVENTIONS.118.007101.
Khan N, Haq HU, Sahito SH, Naqvi SZR, Ishaq W, Bhatti SM. Using a Transradial Method, The Results of Primary Percutaneous Coronary Intervention at a Tertiary Care Cardiac Centre. Pakistan J Med Heal Sci 2023;17:732–5. https://doi.org/10.53350/pjmhs2023173732.
Khan N, Jan MW, Ullah R. The Influence of Presentation Timing and Door to Balloon Timing on the Clinical Outcomes in Primary Percutaneous Coronary Intervention. Pakistan J Heal Sci 2023:181–6. https://doi.org/10.54393/pjhs.v4i10.1125.
Sohail H, Umer MR, Afzal MW, Ullah A, Salahuddin SA, Malik J, et al. Sociodemographic determinants of gender disparity in primary percutaneous coronary intervention in Pakistan. Expert Rev Cardiovasc Ther 2023;21:895–9. https://doi.org/10.1080/14779072.2023.2277356.
Amoras TSG, Rodrigues TB, Menezes CR, Zaninotto CV, Tavares R dos S. Door-to-balloon Time in Cardiovascular Emergency Care in a Hospital of Northern Brazil. Int J Cardiovasc Sci 2020. https://doi.org/10.36660/ijcs.20190104.
Rashid M, Wells G, So D, Chong Y, Dick A, Froeschl M, et al. Off-Hours Presentation, Door-to-Balloon Time, and Clinical Outcomes in Patients Referred for Primary Percutaneous Coronary Intervention. J Invasive Cardiol 2023;35. https://doi.org/10.25270/jic/22.00367.
Nozari Y, Geraiely B, Alipasandi K, Mortazavi SH, Omidi N, Aghajani H, et al. Time to Treatment and In-Hospital Major Adverse Cardiac Events Among Patients With ST-Segment Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention (PCI) According to the 24/7 Primary PCI Service Registry in Iran: Cross-. Interact J Med Res 2020;9:e20352. https://doi.org/10.2196/20352.
Berga Congost G, Martinez Momblan M, Valverde Bernal J, Marquez Lopez A, Ruiz Gabalda J, Garcia Picart J, et al. Predictors of delay in door-to-balloon time in STEMI patients, treated in centers capable in primary PCI. Eur J Cardiovasc Nurs 2021;20. https://doi.org/10.1093/eurjcn/zvab060.023.
Butt TS, Bashtawi E, Bououn B, Wagley B, Albarrak B, Sergani H El, et al. Door-to-balloon time in the treatment of ST segment elevation myocardial infarction in a tertiary care center in Saudi Arabia. Ann Saudi Med 2020;40:281–9. https://doi.org/10.5144/0256-4947.2020.281.
Artani A, Baloch F, Laghari A, Siddiqui F, Artani M, Kazmi K. Sex-stratified outcomes of primary percutaneous coronary intervention: A tertiary care experience. Asian Cardiovasc Thorac Ann 2022;30:164–70. https://doi.org/10.1177/02184923211014001.
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