title: Current status of emergency care for ST-elevation myocardial infarction in an urban setting in Japan.
abstract: BACKGROUND
  The door-to-balloon time (DTB) is an important predictor of the outcome for patients with ST-elevation myocardial infarction (STEMI). In Japan, percutaneous coronary intervention (PCI) can be performed at many hospitals, and the predominant strategy for reperfusion therapy is primary PCI. However, it remains unclear how rapidly reperfusion is achieved at these hospitals.
  
  
  RESULTS
  The study group comprised 369 patients with STEMI who presented within 12 h of symptom onset to a tertiary emergency center (TEC) or at 11 community hospitals (CHs) in 2006 and underwent emergency coronary angiography. Median DTB was shorter in the TEC (63 vs 104 min, P<0.001), and the rate of DTB within 90 min was higher in the TEC (96% vs 39%, P<0.001). Lateral myocardial infarction, presentation during off-hours, and non-cardiologist as the first-contact physician were significantly associated with a prolonged DTB in CHs. There was a trend toward lower 30-day mortality from all causes in the TEC (2.0% vs 4.8%, P=0.08). Multiple logistic regression analysis demonstrated that prolonged DTB (>90 min) was an independent predictor of 30-day mortality (odds ratio 12.6; 95% confidence interval 1.85-86.2, P=0.01).
  
  
  CONCLUSIONS
  Establishment of emergency cardiac care systems with the goal of DTB within 90 min is required in PCI-capable hospitals to improve clinical outcomes.
authors.affiliation: Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Nakayama
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kimura
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Endo
authors.forename: Kazuki
authors.initials: K
authors.lastname: Fukui
authors.forename: Hideo
authors.initials: H
authors.lastname: Himeno
authors.forename: Yuji
authors.initials: Y
authors.lastname: Iwasawa
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Mochida
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Morita
authors.forename: Makoto
authors.initials: M
authors.lastname: Shimizu
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Shimizu
authors.forename: Takahiro
authors.initials: T
authors.lastname: Takei
authors.forename: Keiko
authors.initials: K
authors.lastname: Yoshida
authors.forename: Atsushi
authors.initials: A
authors.lastname: Wada
authors.forename: Satoshi
authors.initials: S
authors.lastname: Umemura
mesh_terms: D000046:Academic Medical Centers / Q000592:standards / Q000706:statistics & numerical data; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002309:Cardiology / Q000706:statistics & numerical data; D017023:Coronary Angiography; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000592:standards / Q000706:statistics & numerical data; D004635:Emergency Medicine / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data; D006764:Hospitals, Community / Q000592:standards / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013997:Time Factors