Minimizing Door-to-Balloon Time Is Not the Most Critical Factor in Improving Clinical Outcome of ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention

作者：Ho Yuan Chih^*; Tsai Tzu Hsien; Sung Pei Hsun; Chen Yung Lung; Chung Sheng Ying; Yang Cheng Hsu; Chen Shyh Ming; Chen Chien Jen; Fang Hsiu Yu; Wu Chiung Jen; Yip Hon Kan

来源：Critical Care Medicine, 2014, 42(8): 1788-1796.

DOI：10.1097/CCM.0000000000000329

• 30-day clinical outcome
• door-to-balloon time
• ST-elevation myocardial infarction

Objectives: We tested the hypothesis that, as compared with conventional door-to-balloon, shortened door-to-balloon time would further improve 30-day outcome in ST-elevation myocardial infarction patients undergoing primary stenting. %26lt;br%26gt;Design: Retrospective cohort study %26lt;br%26gt;Setting: Academic tertiary care hospital with approximately 2600 beds %26lt;br%26gt;Patients: Between January 2008 and December 2009, 266 ST-elevation myocardial infarction patients underwent primary stenting with conventional Door-to-baloon were consecutively enrolled as group 1, while 293 ST-elevation myocardial infarction patients underwent primary stenting with shortened door-to-balloon between January 2010 and December 2011 were consecutively enrolled as group 2. %26lt;br%26gt;Intervention: Shorten door-to-balloon time. %26lt;br%26gt;Measurements and Main Results: The results showed that time from chest pain onset to door did not differ between two groups (p %26gt; 0.1), whereas -door-to-balloon time was significantly reduced in group 2 compared with that in group 1 (p %26lt; 0.0001). The prevalences of successful reperfusion, acute and subacute stent thrombosis, 30-day death or combined endpoint (defined as congestive heart failure %26gt;= New York Heart Association functional class 3 or 30-d death), and left ventricular function did not differ between two groups (all p %26gt; 0.05), whereas the peak creatine phosphokinase level was significantly reduced in group 2 (%26lt; 0.05). Further analysis showed that shortening the chest pain-to-reperfusion time to less than 240 minutes was the most important factor in improving left ventricular p %26lt; 0.001) and 30-day combined endpoint. Multivariate analysis showed that congestive heart failure greater than or equal to New York Heart Association functional class 3, poor left ventricular function, and age (all p %26lt; 0.001) along with unsuccessful reperfusion (p = 0.25) were independently predictive of 30-day mortality. %26lt;br%26gt;Conclusion: Shortening the duration between chest pain onset and reperfusion to less than 4.0 hours was critical in reducing myocardial necrosis and improving heart function and 30-day mortality.

• 出版日期2014-8
• 单位长春大学