TY - JOUR
T1 - 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)
AU - Kuno, Toshiki
AU - Kohsaka, Shun
AU - Numasawa, Yohei
AU - Ueda, Ikuko
AU - Suzuki, Masahiro
AU - Nakamura, Iwao
AU - Negishi, Koji
AU - Ishikawa, Shiro
AU - Maekawa, Yuichiro
AU - Kawamura, Akio
AU - Miyata, Hiroaki
AU - Fukuda, Keiichi
N1 - Funding Information:
This research was supported by a grant from the Ministry of Education, Culture, Sports, Science, and Technology , Japan (KAKENHI No. 25460630 and 25460777 ). The Japanese Cardiovascular Database Steering Committee was responsible for overall study guidance, including the study protocol, data analyses, and interpretation of results. The Department of Healthcare Quality Assessment at Tokyo University independently managed the database. The KICS Scientific Committee managed the participating sites and provided monthly on-site monitoring services to assure data accuracy and completeness throughout the study. During the planning, implementation, and reporting of this study, there were no issues such as conflicts of interest, conflicts of responsibility, or intellectual property right concerns.
Publisher Copyright:
© 2015 Elsevier Inc.
PY - 2015/3/1
Y1 - 2015/3/1
N2 - 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.
AB - 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.
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U2 - 10.1016/j.amjcard.2014.12.004
DO - 10.1016/j.amjcard.2014.12.004
M3 - Article
C2 - 25577426
AN - SCOPUS:84923044568
VL - 115
SP - 581
EP - 586
JO - American Journal of Cardiology
JF - American Journal of Cardiology
SN - 0002-9149
IS - 5
ER -