Abstract 14227: The Impact of Door to Balloon Time is attenuated by “Self-Triage” in Patients With STEMI
Background: ST-elevation myocardial infarction (STEMI) is urgent disease with poor in-hospital mortality. The guidelines recommend that the time from arrival at hospital to reperfusion (Door to Balloon Time: DBT) is to be within 90 min. It is reported that despite longer DBT in patients who arrived by self-transport (Self-triage) than patients using emergent medical services (EMS), in-hospital mortality was lower in the patients with Self-triage.The aim of our study is to investigate the impact of DBT on the in-hospital mortality rate in the patients with Self-Triage.
Methods and Results: We analyzed 1,172 STEMI patients who were underwent primary PCI from January 2009 to December 2013 in AMI Kyoto Registry. In comparison with the EMS group, Self-Triage group were younger and had less cases with Killip classification of 2 or greater. DBT were significantly longer in the Self-triage group (150 min vs. 70 min, p < 0.01), however the in-hospital mortality rate was lower in the Self-Triage group than EMS group (3.3 % vs. 7.1 %, p < 0.01). DBT of 90 min or less was not an independent factor of the in-hospital mortality in the patients with Self-triage. To determine the influence of DBT in the patients with Self-Triage, we categorized cases into subgroups by Killip classification, onset to hospital arrival time (Onset to Door Time: ODT) and combinations of them. In the EMS group, DBT of 90 min or less was significantly associated with the in-hospital mortality in the all subgroups, whereas we could found that DBT of 90 min or less had no significant impact on in-hospital mortality in the patients with Self-Triage regardless of high Killip classification or short ODT.
Conclusion: The present study demonstrated that there was no relationship between in-hospital prognosis and DBT of 90 min or less in the patients with Self-Triage patients even in this primary PCI era. It is suggested that prognosis of the patients for STEMI with Self-Triage cannot be improved by merely focusing on DBT.
Author Disclosures: N. Kodama: None. T. Nakamura: None. K. Yanishi: None. N. Nakanishi: None. K. Zen: None. T. Yamano: None. H. Shiraishi: None. T. Shirayama: None. J. shiraishi: None. T. Sawada: None. Y. Kono: None. M. Kitamura: None. K. Furukawa: None. S. Matoba: None.
- © 2016 by American Heart Association, Inc.