title: Location of the culprit coronary lesion and its association with delay in door-to-balloon time (from a multicenter registry of primary percutaneous coronary intervention).
abstract: Current guidelines recommend shorter door-to-balloon times (DBTs) (<90 minutes) for patients with ST-elevation myocardial infarction (STEMI). Clinical factors, including patient or hospital characteristics, associated with prolonged DBT have been identified, but angiographic variables such as culprit lesion location have not been thoroughly investigated. We aimed to evaluate the effect of culprit artery location on DBT of patients with STEMI who underwent percutaneous coronary intervention (PCI). Data were analyzed from 1,725 patients with STEMI who underwent PCI from August 2008 to March 2014 at 16 Japanese hospitals. Patients were divided into 3 groups according to culprit artery location, right coronary artery (RCA), left anterior descending artery (LAD), and left circumflex artery (LC), and associations with DBT were assessed. The LC group had a trend toward a longer DBT among the 3 groups (97.1 [RCA] vs 98.1 [LAD] vs 105.1 [LC] minutes; p = 0.058). In-hospital mortality was also significantly higher in patients with a left coronary artery lesion (3.5% [RCA] vs 6.3% [LAD] vs 5.4% [LC]; p = 0.041). In-hospital mortality for patients with DBT >90 minutes was significantly higher compared with patients with DBT ≤90 minutes (6.5% vs 3.6%; p = 0.006). Multivariate logistic regression analysis revealed that the LC location was an independent predictor for DBT >90 minutes (odds ratio, 1.45; 95% confidence interval, 1.04 to 2.01; p = 0.028). In conclusion, LC location was an independent predictor of longer DBT. The difficulties in diagnosing LC-related STEMI need further evaluation.
authors.affiliation: Department of Cardiology, Ashikaga Red Cross Hospital, Tochigi, Japan.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Kuno
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan. Electronic address: sk@z3.keio.jp.
authors.forename: Shun
authors.initials: S
authors.lastname: Kohsaka
authors.affiliation: Department of Cardiology, Ashikaga Red Cross Hospital, Tochigi, Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Numasawa
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Ikuko
authors.initials: I
authors.lastname: Ueda
authors.affiliation: Department of Cardiology, Saitama National Hospital, Saitama, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: Department of Cardiology, Hino City Hospital, Tokyo, Japan.
authors.forename: Iwao
authors.initials: I
authors.lastname: Nakamura
authors.affiliation: Department of Cardiology, Yokohama Municipal Hospital, Kanagawa, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Negishi
authors.affiliation: Department of Cardiology, Saitama City Hospital, Saitama, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Ishikawa
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Maekawa
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Kawamura
authors.affiliation: Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Miyata
authors.affiliation: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Fukuda
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D012042:Registries; D061665:Time-to-Treatment / Q000706:statistics & numerical data*