Division of Cardiovascular Diseases and Internal Medicine, Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann Street, Tel-Aviv, Israel.
Clin Res Cardiol. 2019 Sep;108(9):1053-1058. doi: 10.1007/s00392-019-01438-6. Epub 2019 Feb 18.
Current guidelines for the treatment of ST-segment elevation myocardial infarction (STEMI) recommend a door-to-balloon time (DBT) of ≤ 90 min for patients undergoing primary percutaneous coronary intervention (PCI). We aimed to investigate the possible impact of further reduction in DBT intervals beyond the 90 min cutoff on short and long-term outcomes among STEMI patients undergoing primary PCI.
We retrospectively studied 889 STEMI patients (median age 61 years, 83% men) who underwent successful primary PCI and had a DBT of ≤ 90 min. Patients were stratified according to DBT into 2 groups: < 60 min and 60-90 min. Patients records were assessed for the occurrence of in-hospital complications, 30-day and 1-year mortality.
Patients having DBT < 60 min (n = 608, 68%) were more likely to present earlier, in daytime and weekdays, and had better post-procedural left ventricular ejection fraction and lower 30-day mortality (3% vs. 6%, p = 0.03). Mortality over 1-year was significantly lower among patients having DBT < 60 compared to DBT of 60-90 min (4.6% vs. 9.6%, p = 0.004). In a binary logistic regression model DBT < 60 min was associated with 51% risk reduction for 1-year mortality (OR 0.49, 95% CI 0.25-0.93, p = 0.03).
Among STEMI patients undergoing primary PCI within 90 min of admission DBT < 60 min was independently associated with better 1-year mortality.
目前，治疗 ST 段抬高型心肌梗死（STEMI）的指南建议行直接经皮冠状动脉介入治疗（PCI）的患者门球时间（DBT）应≤90 分钟。我们旨在研究在 90 分钟截止时间内进一步缩短 DBT 间隔对行直接 PCI 的 STEMI 患者的短期和长期结局的可能影响。
我们回顾性研究了 889 名成功接受直接 PCI 且 DBT≤90 分钟的 STEMI 患者（中位年龄 61 岁，83%为男性）。根据 DBT 将患者分为 2 组：<60 分钟和 60-90 分钟。评估患者记录以了解住院并发症、30 天和 1 年死亡率的发生情况。
DBT<60 分钟的患者（n=608，68%）更可能更早就诊，在白天和工作日就诊，且术后左心室射血分数更好，30 天死亡率更低（3% vs. 6%，p=0.03）。DBT<60 分钟的患者在 1 年死亡率明显低于 DBT 为 60-90 分钟的患者（4.6% vs. 9.6%，p=0.004）。在二项逻辑回归模型中，DBT<60 分钟与 1 年死亡率降低 51%相关（OR 0.49，95%CI 0.25-0.93，p=0.03）。
在 90 分钟内入院行直接 PCI 的 STEMI 患者中，DBT<60 分钟与较低的 1 年死亡率独立相关。
