title: Culprit Vessel Revascularization Prior to Diagnostic Angiography as a Strategy to Reduce Delays in Primary Percutaneous Coronary Intervention: A Propensity-Matched Analysis.
abstract: BACKGROUND
  Delays are important markers of quality of care in primary percutaneous coronary intervention. There is scarce data on the impact of obtaining a complete diagnostic angiography before primary percutaneous coronary intervention.
  
  
  RESULTS
  Consecutive patients treated with primary percutaneous coronary intervention at our institution between January 2012 and December 2014 were studied. After excluding patients with prior coronary artery bypass surgery, 925 patients were included in the analysis. Patients were classified into 3 groups according to the as-treated revascularization strategy: culprit-vessel revascularization first, contralateral angiography first, or complete angiography first. Propensity score matching was used to minimize difference in clinical characteristics between groups. Predictors of culprit-vessel first revascularization were anterior/lateral infarct location and absence of diabetes mellitus. After propensity score matching, the median vascular access-to-balloon time was 4 to 6 minutes shorter with a culprit-vessel revascularization first strategy. This reduction in time to reperfusion increased the proportion of patients treated within recommended delays. However, there was no significant difference in 30-day clinical outcomes associated with these delays reduction.
  
  
  CONCLUSIONS
  Performing culprit-vessel primary percutaneous coronary intervention before contralateral or complete diagnostic angiography is associated with a statistically significant reduction in vascular access-to-balloon time, although the 4- to 6-minute difference is unlikely to be clinically relevant. This small but significant reduction could translate in an augmentation in the proportion of patients treated within recommended delays.
authors.affiliation: From the Department of Medicine, Centre Hospitalier Universitaire de Sherbrooke/Université de Sherbrooke, Sherbrooke, Canada (E.L.C., S.B., K.D., A.G., R.H., M.N., B.D.); and Department of Medicine, Université de Sherbrooke, Faculty of Medicine, Sherbrooke, Canada (É.P.).
authors.forename: Etienne L
authors.initials: EL
authors.lastname: Couture
authors.affiliation: From the Department of Medicine, Centre Hospitalier Universitaire de Sherbrooke/Université de Sherbrooke, Sherbrooke, Canada (E.L.C., S.B., K.D., A.G., R.H., M.N., B.D.); and Department of Medicine, Université de Sherbrooke, Faculty of Medicine, Sherbrooke, Canada (É.P.).
authors.forename: Simon
authors.initials: S
authors.lastname: Bérubé
authors.affiliation: From the Department of Medicine, Centre Hospitalier Universitaire de Sherbrooke/Université de Sherbrooke, Sherbrooke, Canada (E.L.C., S.B., K.D., A.G., R.H., M.N., B.D.); and Department of Medicine, Université de Sherbrooke, Faculty of Medicine, Sherbrooke, Canada (É.P.).
authors.forename: Karl
authors.initials: K
authors.lastname: Dalery
authors.affiliation: From the Department of Medicine, Centre Hospitalier Universitaire de Sherbrooke/Université de Sherbrooke, Sherbrooke, Canada (E.L.C., S.B., K.D., A.G., R.H., M.N., B.D.); and Department of Medicine, Université de Sherbrooke, Faculty of Medicine, Sherbrooke, Canada (É.P.).
authors.forename: André
authors.initials: A
authors.lastname: Gervais
authors.affiliation: From the Department of Medicine, Centre Hospitalier Universitaire de Sherbrooke/Université de Sherbrooke, Sherbrooke, Canada (E.L.C., S.B., K.D., A.G., R.H., M.N., B.D.); and Department of Medicine, Université de Sherbrooke, Faculty of Medicine, Sherbrooke, Canada (É.P.).
authors.forename: Richard
authors.initials: R
authors.lastname: Harvey
authors.affiliation: From the Department of Medicine, Centre Hospitalier Universitaire de Sherbrooke/Université de Sherbrooke, Sherbrooke, Canada (E.L.C., S.B., K.D., A.G., R.H., M.N., B.D.); and Department of Medicine, Université de Sherbrooke, Faculty of Medicine, Sherbrooke, Canada (É.P.).
authors.forename: Michel
authors.initials: M
authors.lastname: Nguyen
authors.affiliation: From the Department of Medicine, Centre Hospitalier Universitaire de Sherbrooke/Université de Sherbrooke, Sherbrooke, Canada (E.L.C., S.B., K.D., A.G., R.H., M.N., B.D.); and Department of Medicine, Université de Sherbrooke, Faculty of Medicine, Sherbrooke, Canada (É.P.).
authors.forename: Émilie
authors.initials: É
authors.lastname: Parenteau
authors.affiliation: From the Department of Medicine, Centre Hospitalier Universitaire de Sherbrooke/Université de Sherbrooke, Sherbrooke, Canada (E.L.C., S.B., K.D., A.G., R.H., M.N., B.D.); and Department of Medicine, Université de Sherbrooke, Faculty of Medicine, Sherbrooke, Canada (É.P.). benoit.daneault@usherbrooke.ca.
authors.forename: Benoit
authors.initials: B
authors.lastname: Daneault
mesh_terms: D000368:Aged; D000792:Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D057216:Propensity Score; D058996:Quality Improvement; D012189:Retrospective Studies; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: coronary angiography; culprit vessel; diabetes mellitus; door-to-balloon time; primary percutaneous coronary intervention