Department of Cardiology, Rambam Health Care Campus, Haifa.
Department of Epidemiology, Biostatistics, and Community Health Sciences, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva.
Coron Artery Dis. 2022 Aug 1;33(5):341-348. doi: 10.1097/MCA.0000000000001145. Epub 2022 Mar 8.
This study examines relationships between door to balloon (D2B) time and subsequent admissions due to heart failure (HF), acute coronary syndrome (ACS), and mortality for up to 1 year.
Current guidelines set 90-min for D2B time for primary percutaneous coronary intervention (PPCI) as a goal, which has been shown to reduce mortality and adverse events.
Using the MDclone ADAMS system integrated with our electronic medical records, we conducted retrospective analysis of all patients admitted due to ST-elevation myocardial infarction from home, without any history of HF or coronary disease, and who underwent PPCI during 2013-2019. Data on D2B time, baseline clinical and demographic characteristics, and outcomes of HF, ACS and mortality were collected. Adjusted HR for each of the outcomes was calculated by multivariate Cox model.
A total of 826 patients were included in the final analysis. D2B had no significant effect on incidence of heart failure admissions for up to 1-year follow-up. D2B had a significant effect on mortality at 180 days, showing a 30% increase for each 30-min increase (HR 1.308; CI, 1.046-1.635) as for ACS at 90 days (HR 1.307; 1.025-1.638). The 30-min D2B cutoff showed a significant increase in ACS recurrence throughout the follow-up period at 90 days (HR 2.871, 1.239-6.648), 180 days (HR 2.607, 1.255-5.413), and 1 year (HR 1.886, 1.073-3.317).
Patients with shorter D2B times had significantly reduced mortality and recurrence of ACS, with no effect on heart failure admission incidence.
本研究探讨了门到球囊（D2B）时间与心力衰竭（HF）、急性冠状动脉综合征（ACS）和 1 年内死亡相关的后续入院之间的关系。
目前的指南规定原发性经皮冠状动脉介入治疗（PPCI）的 D2B 时间为 90 分钟，这已被证明可以降低死亡率和不良事件发生率。
使用 MDclone ADAMS 系统与我们的电子病历相结合，我们对 2013 年至 2019 年间因 ST 段抬高型心肌梗死从家中入院、无 HF 或冠状动脉疾病史且接受 PPCI 的所有患者进行了回顾性分析。收集 D2B 时间、基线临床和人口统计学特征以及 HF、ACS 和死亡率的结果数据。通过多变量 Cox 模型计算每种结果的调整 HR。
共纳入 826 例患者进行最终分析。在长达 1 年的随访中，D2B 对心力衰竭入院的发生率没有显著影响。D2B 对 180 天的死亡率有显著影响，每增加 30 分钟，死亡率增加 30%（HR 1.308；CI，1.046-1.635），90 天的 ACS 发生率也有显著影响（HR 1.307；1.025-1.638）。D2B 每 30 分钟的时间截止值显示，在整个随访期间，90 天（HR 2.871，1.239-6.648）、180 天（HR 2.607，1.255-5.413）和 1 年（HR 1.886，1.073-3.317）时 ACS 复发的风险显著增加。
D2B 时间较短的患者死亡率和 ACS 复发率显著降低，HF 入院发生率无影响。
