title: Barriers Associated With Door-to-Balloon Delay in Contemporary Japanese Practice.
abstract: Door-to-balloon (DTB) time ≤90 min is an important quality indicator in the management of ST-elevation myocardial infarction (STEMI), but a considerable number of patients still do not meet this goal, particularly in countries outside the USA and Europe.
  
  
  
  We analyzed 2,428 STEMI patients who underwent primary PCI ≤12 h of symptom onset who were registered in an ongoing prospective multicenter database (JCD-KiCS registry), between 2008 and 2013. We analyzed both the time trend in DTB time within this cohort in the registry, and independent predictors of delayed DTB time >90 min. Median DTB time was 90 min (IQR, 68-115 min) during the study period and there were no significant changes with year. Predictors for delay in DTB time included peripheral artery disease, prior revascularization, off-hour arrival, age >75 years, heart failure at arrival, and use of IABP or VA-ECMO. Notably, high-volume PCI-capable institutions (PCI ≥200/year) were more adept at achieving shorter DTB time compared with low-volume institutions (PCI <200/year).
  
  
  
  Half of the present STEMI patients did not achieve DTB time ≤90 min. Targeting the elderly and patients with multiple comorbidities, and PCI performed in off-hours may aid in its improvement.
authors.affiliation: Department of Cardiology, Keio University School of Medicine.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Ikemura
authors.affiliation: Department of Cardiology, Keio University School of Medicine.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Sawano
authors.affiliation: Department of Cardiology, Keio University School of Medicine.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Shiraishi
authors.affiliation: Department of Cardiology, Keio University School of Medicine.
authors.forename: Ikuko
authors.initials: I
authors.lastname: Ueda
authors.affiliation: Department of Health Policy and Management, Keio University School of Medicine.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Miyata
authors.affiliation: Department of Cardiology, Japanese Red Cross Ashikaga Hospital.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Numasawa
authors.affiliation: Department of Cardiology, Saiseikai Utsunomiya Hospital.
authors.forename: Shigetaka
authors.initials: S
authors.lastname: Noma
authors.affiliation: Department of Cardiology, National Hospital Organization, Saitama National Hospital.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: Department of Cardiology, National Hospital Organization, Tokyo Medical Center.
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Momiyama
authors.affiliation: Department of Cardiology, Keio University School of Medicine.
authors.forename: Taku
authors.initials: T
authors.lastname: Inohara
authors.affiliation: Department of Cardiology, Keio University School of Medicine.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Hayashida
authors.affiliation: Department of Cardiology, Keio University School of Medicine.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Yuasa
authors.affiliation: Department of Cardiology, Keio University School of Medicine.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Maekawa
authors.affiliation: Department of Cardiology, Keio University School of Medicine.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Fukuda
authors.affiliation: Department of Cardiology, Keio University School of Medicine.
authors.forename: Shun
authors.initials: S
authors.lastname: Kohsaka
mesh_terms: D000368:Aged; D005260:Female; D006760:Hospitalization; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D012042:Registries; D000072657:ST Elevation Myocardial Infarction; D013997:Time Factors
keywords: Acute coronary syndrome; Door-to-balloon time; Reperfusion; ST-segment elevation myocardial infarction