title: Effect on door-to-balloon time of immediate transradial percutaneous coronary intervention on culprit lesion in ST-elevation myocardial infarction compared to diagnostic angiography followed by primary percutaneous coronary intervention.
abstract: Door-to-balloon (DTB) time is an important metric in primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction to optimize clinical outcomes. The aim of this study was to compare the impact of immediate PCI on culprit lesions in patients with ST-segment elevation myocardial infarctions versus diagnostic angiography followed by PCI on DTB times and procedural data at a high-volume tertiary care radial center. All patients who underwent primary PCI <12 hours after symptom onset were studied. Procedural data and all-cause mortality were assessed in all patients. The primary outcome was DTB time. From January 2006 to June 2011, 1,900 patients were included and divided into 2 groups: 562 patients (30%) underwent primary PCI followed by contralateral diagnostic angiography, and 1,338 patients (70%) underwent diagnostic angiography before primary PCI. No significant differences were observed in baseline characteristics. Left anterior descending coronary artery-related ST-segment elevation myocardial infarctions were more often found in patients who underwent PCI first (54% vs 34%, p <0.0001). Overall, there was a reduction of 8 minutes in DTB time between patients who underwent PCI first and those who underwent angiography first (32 minutes [interquartile range 24 to 52] vs 40 minutes [interquartile range 30 to 69], respectively, p <0.0001). After adjustment, immediate PCI remained an independent predictor of DTB time ≤90 minutes (odds ratio 2.42, 95% confidence interval 1.70 to 3.52, p <0.0001). There were no differences in early and late clinical outcomes. In conclusion, a strategy of transradial direct PCI of the infarct-related artery in selected patients before complete coronary angiography was associated with a benefit of 8 minutes in DTB time. Further study is required to determine whether this strategy can favorably affect clinical outcomes.
authors: Quebec Heart-Lung Institute, Quebec City, Quebec, Canada.
authors: Guillaume
authors: G
authors: Plourde
authors: Eltigani
authors: E
authors: Abdelaal
authors: Yoann
authors: Y
authors: Bataille
authors: Jimmy
authors: J
authors: MacHaalany
authors: Jean-Pierre
authors: JP
authors: Déry
authors: Ugo
authors: U
authors: Déry
authors: Éric
authors: É
authors: Larose
authors: Robert
authors: R
authors: De Larochellière
authors: Onil
authors: O
authors: Gleeton
authors: Gérald
authors: G
authors: Barbeau
authors: Louis
authors: L
authors: Roy
authors: Olivier
authors: O
authors: Costerousse
authors: Olivier F
authors: OF
authors: Bertrand
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000401:mortality; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome