Title |
Barriers Associated With Door-to-Balloon Delay in Contemporary Japanese Practice
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Published in |
Circulation Journal, February 2017
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DOI | 10.1253/circj.cj-16-0905 |
Pubmed ID | |
Authors |
Nobuhiro Ikemura, Mitsuaki Sawano, Yasuyuki Shiraishi, Ikuko Ueda, Hiroaki Miyata, Yohei Numasawa, Shigetaka Noma, Masahiro Suzuki, Yukihiko Momiyama, Taku Inohara, Kentaro Hayashida, Shinsuke Yuasa, Yuichiro Maekawa, Keiichi Fukuda, Shun Kohsaka |
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.Methods and Results: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. |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 46 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Researcher | 10 | 22% |
Other | 5 | 11% |
Student > Bachelor | 5 | 11% |
Student > Doctoral Student | 3 | 7% |
Student > Ph. D. Student | 3 | 7% |
Other | 9 | 20% |
Unknown | 11 | 24% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 24 | 52% |
Nursing and Health Professions | 4 | 9% |
Pharmacology, Toxicology and Pharmaceutical Science | 1 | 2% |
Biochemistry, Genetics and Molecular Biology | 1 | 2% |
Neuroscience | 1 | 2% |
Other | 2 | 4% |
Unknown | 13 | 28% |