JMIR Publications

ABSTRACT

Background:

Performing primary percutaneous coronary intervention (PCI), as a preferred reperfusion strategy, for patients with ST-segment elevation myocardial infarction (STEMI) may be associated with major adverse cardio-cerebrovascular events (MACCEs). Thus, timely performing primary PCI has been emphasized in order to improve outcomes. Despite guideline recommendations on trying to reduce door-to-balloon (D2B) time of less than 90 minutes in order to reduce mortality, less attention has been paid to other components of time to treatment such as symptom-to-balloon (S2B) time as an indicator of the total ischemic time, which constitute of symptom-to-door (S2D) time and D2B, on clinical outcomes of patients with STEMI underwent primary PCI.

Objective:

We aimed to determine the association between each component of time to treatment (i.e. S2B time, D2B time and S2B time) and in-hospital MACCEs among patients with STEMI underwent primary PCI.

Methods:

In this observational study, according to prospective primary PCI 24/7 service registry, adult patients with STEMI underwent primary PCI in one of the six catheterization laboratories of the Tehran Heart Center from November 2015 to August 2019 were studied. Those patients who treated with fibrinolytic and having incomplete data regarding treatment times and in-hospital MACCEs were excluded from the analysis process. The primary outcome was in-hospital MACCEs which was a composite index consisting of cardiac death, revascularization (i.e. target vessel revascularization (TVR) / target lesion revascularization (TLR), MI, and stroke which was compared at different levels of time to treatment (i.e. S2D & D2B < 90 and ≥ 90 minutes, and S2B time <180 and ≥180 minutes). Data were analyzed by SPSS software version 24, by descriptive statistics such as frequency, percentage, mean and standard deviation, and statistical tests such as chi-square, t-test, univariate and multivariate binary logistic regression with a significance level of less than .05 and 95% CI for odds ratio (OR).

Results:

Data from 2,823 out of 3204 patients were analyzed with a mean age of 59.6 (11/6) years and 79.5% of male sex (completion rate: 88.1%). The median of DBT was 55 (40-92) minutes and DBT ≤ 90 minutes was seen among the most of the patients. While the median of SDT and SBT were 258(108-574) and 355(180-720) minutes, respectively. And, the low proportion of SDT ≤ 90 minutes and SBT ≤ 180 minutes were observed among the study patients (20.5 % and 24.5 %, respectively). Overall, 2.4% of the patients experienced in-hospital MACCEs, and cardiac death (1.6%) was the most common cardiac outcome. In the univariate analysis, S2B time predicted the in-hospital MACCEs (OR = 2.2; 95% CI: 1.1-4.4, P =.029), while S2D time (OR = 1.4; 95% CI: 0.7-2.6; P=.343) and D2B time (OR = 1.1; 95% CI: 0.6-1.8, P= .769) were not associated with in-hospital MACCES. In the multivariate analysis, only S2B time ≥ 180 minutes was associated with in-hospital MACCEs and was a predictor of in-hospital MACCEs (OR = 2.3; 95% CI: 1.1-5.2, P =.041).

Conclusions:

From different components of time to treatment, longer S2B time was associated with higher in-hospital MACCEs in the present study. Efforts should be made to shorten S2B time in order to improve in-hospital MACCEs.