Direct Admission of Patients With ST‐Segment–Elevation Myocardial Infarction to the Catheterization Laboratory Shortens Pain‐to‐Balloon and Door‐to‐Balloon Time Intervals but Only the Pain‐to‐Balloon Interval Impacts Short‐ and Long‐Term Mortality
Background Shortening the pain‐to‐balloon (P2B) and door‐to‐balloon (D2B) intervals in patients with ST‐segment–elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PPCI) is essential in order to limit myocardial damage. We investigated whether direct admiss...
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-01-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.018343 |
| _version_ | 1811334160754671616 |
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| author | Simcha R. Meisel Michael Kleiner‐Shochat Rami Abu‐Fanne Aaron Frimerman Asaf Danon Sa’ar Minha Yaniv Levi Alex Blatt Jameel Mohsen Avraham Shotan Ariel Roguin |
| author_facet | Simcha R. Meisel Michael Kleiner‐Shochat Rami Abu‐Fanne Aaron Frimerman Asaf Danon Sa’ar Minha Yaniv Levi Alex Blatt Jameel Mohsen Avraham Shotan Ariel Roguin |
| author_sort | Simcha R. Meisel |
| collection | DOAJ |
| description | Background Shortening the pain‐to‐balloon (P2B) and door‐to‐balloon (D2B) intervals in patients with ST‐segment–elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PPCI) is essential in order to limit myocardial damage. We investigated whether direct admission of PPCI‐treated patients with STEMI to the catheterization laboratory, bypassing the emergency department, expedites reperfusion and improves prognosis. Methods and Results Consecutive PPCI‐treated patients with STEMI included in the ACSIS (Acute Coronary Syndrome in Israel Survey), a prospective nationwide multicenter registry, were divided into patients admitted directly or via the emergency department. The impact of the P2B and D2B intervals on mortality was compared between groups by logistic regression and propensity score matching. Of the 4839 PPCI‐treated patients with STEMI, 1174 were admitted directly and 3665 via the emergency department. Respective median P2B and D2B were shorter among the directly admitted patients with STEMI (160 and 35 minutes) compared with those admitted via the emergency department (210 and 75 minutes, P<0.001). Decreased mortality was observed with direct admission at 1 and 2 years and at the end of follow‐up (median 6.4 years, P<0.001). Survival advantage persisted after adjustment by logistic regression and propensity matching. P2B, but not D2B, impacted survival (P<0.001). Conclusions Direct admission of PPCI‐treated patients with STEMI decreased mortality by shortening P2B and D2B intervals considerably. However, P2B, but not D2B, impacted mortality. It seems that the D2B interval has reached its limit of effect. Thus, all efforts should be extended to shorten P2B by educating the public to activate early the emergency medical services to bypass the emergency department and allow timely PPCI for the best outcome. |
| first_indexed | 2024-04-13T17:03:43Z |
| format | Article |
| id | doaj.art-d6f68e025eb34ca2a4ebf72a32b1f938 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T17:03:43Z |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-d6f68e025eb34ca2a4ebf72a32b1f9382022-12-22T02:38:34ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-01-0110110.1161/JAHA.120.018343Direct Admission of Patients With ST‐Segment–Elevation Myocardial Infarction to the Catheterization Laboratory Shortens Pain‐to‐Balloon and Door‐to‐Balloon Time Intervals but Only the Pain‐to‐Balloon Interval Impacts Short‐ and Long‐Term MortalitySimcha R. Meisel0Michael Kleiner‐Shochat1Rami Abu‐Fanne2Aaron Frimerman3Asaf Danon4Sa’ar Minha5Yaniv Levi6Alex Blatt7Jameel Mohsen8Avraham Shotan9Ariel Roguin10Heart InstituteHillel Yaffe Medical Center Hadera IsraelHeart InstituteHillel Yaffe Medical Center Hadera IsraelHeart InstituteHillel Yaffe Medical Center Hadera IsraelHeart InstituteHillel Yaffe Medical Center Hadera IsraelHeart InstituteHillel Yaffe Medical Center Hadera IsraelShamir Medical Center Zerifin IsraelHeart InstituteHillel Yaffe Medical Center Hadera IsraelKaplan Medical Center Rehovot IsraelHeart InstituteHillel Yaffe Medical Center Hadera IsraelHeart InstituteHillel Yaffe Medical Center Hadera IsraelHeart InstituteHillel Yaffe Medical Center Hadera IsraelBackground Shortening the pain‐to‐balloon (P2B) and door‐to‐balloon (D2B) intervals in patients with ST‐segment–elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PPCI) is essential in order to limit myocardial damage. We investigated whether direct admission of PPCI‐treated patients with STEMI to the catheterization laboratory, bypassing the emergency department, expedites reperfusion and improves prognosis. Methods and Results Consecutive PPCI‐treated patients with STEMI included in the ACSIS (Acute Coronary Syndrome in Israel Survey), a prospective nationwide multicenter registry, were divided into patients admitted directly or via the emergency department. The impact of the P2B and D2B intervals on mortality was compared between groups by logistic regression and propensity score matching. Of the 4839 PPCI‐treated patients with STEMI, 1174 were admitted directly and 3665 via the emergency department. Respective median P2B and D2B were shorter among the directly admitted patients with STEMI (160 and 35 minutes) compared with those admitted via the emergency department (210 and 75 minutes, P<0.001). Decreased mortality was observed with direct admission at 1 and 2 years and at the end of follow‐up (median 6.4 years, P<0.001). Survival advantage persisted after adjustment by logistic regression and propensity matching. P2B, but not D2B, impacted survival (P<0.001). Conclusions Direct admission of PPCI‐treated patients with STEMI decreased mortality by shortening P2B and D2B intervals considerably. However, P2B, but not D2B, impacted mortality. It seems that the D2B interval has reached its limit of effect. Thus, all efforts should be extended to shorten P2B by educating the public to activate early the emergency medical services to bypass the emergency department and allow timely PPCI for the best outcome.https://www.ahajournals.org/doi/10.1161/JAHA.120.018343admission pathwaylong‐term mortalityST‐segment–elevation myocardial infarctionprimary percutaneous coronary intervention |
| spellingShingle | Simcha R. Meisel Michael Kleiner‐Shochat Rami Abu‐Fanne Aaron Frimerman Asaf Danon Sa’ar Minha Yaniv Levi Alex Blatt Jameel Mohsen Avraham Shotan Ariel Roguin Direct Admission of Patients With ST‐Segment–Elevation Myocardial Infarction to the Catheterization Laboratory Shortens Pain‐to‐Balloon and Door‐to‐Balloon Time Intervals but Only the Pain‐to‐Balloon Interval Impacts Short‐ and Long‐Term Mortality Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease admission pathway long‐term mortality ST‐segment–elevation myocardial infarction primary percutaneous coronary intervention |
| title | Direct Admission of Patients With ST‐Segment–Elevation Myocardial Infarction to the Catheterization Laboratory Shortens Pain‐to‐Balloon and Door‐to‐Balloon Time Intervals but Only the Pain‐to‐Balloon Interval Impacts Short‐ and Long‐Term Mortality |
| title_full | Direct Admission of Patients With ST‐Segment–Elevation Myocardial Infarction to the Catheterization Laboratory Shortens Pain‐to‐Balloon and Door‐to‐Balloon Time Intervals but Only the Pain‐to‐Balloon Interval Impacts Short‐ and Long‐Term Mortality |
| title_fullStr | Direct Admission of Patients With ST‐Segment–Elevation Myocardial Infarction to the Catheterization Laboratory Shortens Pain‐to‐Balloon and Door‐to‐Balloon Time Intervals but Only the Pain‐to‐Balloon Interval Impacts Short‐ and Long‐Term Mortality |
| title_full_unstemmed | Direct Admission of Patients With ST‐Segment–Elevation Myocardial Infarction to the Catheterization Laboratory Shortens Pain‐to‐Balloon and Door‐to‐Balloon Time Intervals but Only the Pain‐to‐Balloon Interval Impacts Short‐ and Long‐Term Mortality |
| title_short | Direct Admission of Patients With ST‐Segment–Elevation Myocardial Infarction to the Catheterization Laboratory Shortens Pain‐to‐Balloon and Door‐to‐Balloon Time Intervals but Only the Pain‐to‐Balloon Interval Impacts Short‐ and Long‐Term Mortality |
| title_sort | direct admission of patients with st segment elevation myocardial infarction to the catheterization laboratory shortens pain to balloon and door to balloon time intervals but only the pain to balloon interval impacts short and long term mortality |
| topic | admission pathway long‐term mortality ST‐segment–elevation myocardial infarction primary percutaneous coronary intervention |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.018343 |
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