Tsai Shin-Ho, Hsiao Yu-Ting, Yeh Ya-Ni, Lin Jih-Chun, Zhang Shi-Quan, Tsai Ming-Jen
Ditmanson Medical Foundation Chia-Yi Christian Hospital, Department of Emergency Medicine, Chiayi City, Taiwan.
West J Emerg Med. 2025 Mar;26(2):180-190. doi: 10.5811/westjem.20779.
Timely activation of primary percutaneous coronary intervention (PCI) is crucial for patients with ST-segment elevation myocardial infarction (STEMI). Door-to-balloon (DTB) time, representing the duration from patient arrival to balloon inflation, is critical for prognosis. However, the specific time segment within the DTB that is most associated with long-term mortality remains unclear. In this study we aimed to identify the target time segment within the DTB that is most associated with one-year mortality in STEMI patients.
We conducted a retrospective cohort study at a tertiary teaching hospital. All patients diagnosed with STEMI and activated for primary PCI from the emergency department were identified between January 2013-December 2021. Patient demographics, medical history, triage information, electrocardiogram, troponin-I levels, and coronary angiography reports were obtained. We divided the DTB time into door-to-electrocardiogram (ECG), ECG-to-cardiac catheterization laboratory (cath lab) activation, activation-to-cath lab arrival, and cath lab arrival-to-balloon time. We used Kaplan-Meier survival analysis and multivariable Cox proportional hazards models to determine the independent effects of these time intervals on the risk of one-year mortality.
A total of 732 STEMI patients were included. Kaplan-Meier analysis revealed that delayed door-to-ECG time (>10 min) and cath lab arrival-to-balloon time (>30 min) were associated with a higher risk of one-year mortality (log-rank test, < .001 and = 0.01, respectively). In the multivariable Cox models, door-to-ECG time was a significant predictor for one-year mortality, whether it was analyzed as a dichotomized (>10 min vs ≤10 min) or a continuous variable. The corresponding adjusted hazard ratios (aHR) were 2.81 (95% confidence interval [CI] 1.42-5.55) for the dichotomized analysis, and 1.03 (95% CI 1.00-1.06) per minute increase, respectively. Cath lab arrival-to-balloon time also showed an independent effect on one-year mortality when analyzed as a continuous variable, with an aHR of 1.02 (95% CI 1.00-1.04) per minute increase. However, ECG-to-cath lab activation and activation-to-cath lab arrival times did not show a significant association with the risk of one-year mortality.
Within the door-to-balloon interval, the time from door-to-ECG completion is particularly crucial for one-year survival after STEMI, while cath lab arrival-to-balloon inflation may also be relevant.
对于ST段抬高型心肌梗死（STEMI）患者，及时启动直接经皮冠状动脉介入治疗（PCI）至关重要。门球时间（DTB），即从患者到达至球囊扩张的持续时间，对预后至关重要。然而，DTB中与长期死亡率最相关的具体时间段仍不清楚。在本研究中，我们旨在确定DTB中与STEMI患者一年死亡率最相关的目标时间段。
我们在一家三级教学医院进行了一项回顾性队列研究。确定了2013年1月至2021年12月期间所有从急诊科诊断为STEMI并启动直接PCI的患者。获取了患者的人口统计学资料、病史、分诊信息、心电图、肌钙蛋白I水平和冠状动脉造影报告。我们将DTB时间分为门到心电图（ECG）、心电图到心导管实验室（导管室）激活、激活到导管室到达以及导管室到达至球囊时间。我们使用Kaplan-Meier生存分析和多变量Cox比例风险模型来确定这些时间间隔对一年死亡风险的独立影响。
共纳入732例STEMI患者。Kaplan-Meier分析显示，门到ECG时间延迟（>10分钟）和导管室到达至球囊时间延迟（>30分钟）与一年死亡率较高相关（对数秩检验，分别为<0.001和=0.01）。在多变量Cox模型中，门到ECG时间是一年死亡率的显著预测因素，无论将其作为二分变量（>10分钟与≤10分钟）还是连续变量进行分析。二分变量分析的相应调整后风险比（aHR）为2.81（95%置信区间[CI]1.42-5.55），每分钟增加的aHR为1.03（95%CI 1.00-1.06）。导管室到达至球囊时间作为连续变量分析时，对一年死亡率也显示出独立影响，每分钟增加的aHR为1.02（95%CI 1.00-1.04）。然而，心电图到导管室激活时间和激活到导管室到达时间与一年死亡风险没有显著关联。
在门球间隔内，从门到ECG完成的时间对STEMI后一年生存尤为关键，而导管室到达至球囊扩张时间也可能相关。
