Evaluation of the Causes of Door-to-Balloon Time Delays in Patients with ST-Elevation Myocardial Infarction at Tehran Heart Center
-
Mohammadamin Emami
,
Sara Mirzamohamadi
,
Amirhossein Heidari
,
Afsaneh Aein
,
Mojtaba Salarifar
,
Ebrahim Nematipour
Abstract
Background: Coronary artery disease (CAD) is the leading cause of cardiovascular death globally, and the most severe form of CAD, ST-elevation myocardial infarction (STEMI), needs immediate treatment. This study aimed to report patient characteristics and the causes of door–to–balloon time (D2BT) delays in STEMI patients admitted to Tehran Heart Center with a D2BT exceeding 90 minutes.
Methods: This cross-sectional study was conducted at Tehran Heart Center, Iran, from March 20th, 2020, through March 20th, 2022. Variables consisted of age, sex, diabetes mellitus, hypertension, dyslipidemia, smoking, opium, family history of CAD, in-hospital mortality, primary percutaneous coronary intervention results, culprit vessels, causes of delays, the ejection fraction, triglycerides, and low and high-density lipoprotein levels.
Results: The study population was composed of 363 patients (272 males [74.9]) at a mean (SD) age of 60±11.47 years. The leading causes of D2BT delays were the catheterization lab used in 95 patients (26.2) and misdiagnosis in 90 (24.8). Other causes were ST-elevation less than 2 mm in electrocardiograms in 50 patients (13.8) and referral from other hospitals in 40 (110.).
Conclusion: The catheterization lab in use and misdiagnosis were the leading causes of D2BT delays. We recommend that high-volume centers allocate an additional catheterization lab with an on-call cardiologist. Improved resident training and supervision in hospitals with many residents are also necessary.
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13. Swaminathan RV, Wang TY, Kaltenbach LA, Kim LK, Minutello RM, Bergman G, Wong SC, Feldman DN. Nonsystem reasons for delay in door-to-balloon time and associated in-hospital mortality: a report from the National Cardiovascular Data Registry. J Am Coll Cardiol 2013;61:1688-1695.
14. Redfors B, Mohebi R, Giustino G, Chen S, Selker HP, Thiele H, Patel MR, Udelson JE, Ohman EM, Eitel I, Granger CB, Maehara A, Ali ZA, Ben-Yehuda O, Stone GW. Time Delay, Infarct Size, and Microvascular Obstruction After Primary Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction. Circ Cardiovasc Interv 2021;14:e009879.
15. Varcoe RW, Clayton TC, Gray HH, de Belder MA, Ludman PF, Henderson RA; British Cardiovascular Intervention Society (BCIS) and the National Institute for Cardiovascular Outcomes Research (NICOR). Impact of call-to-balloon time on 30-day mortality in contemporary practice. Heart 2017;103:117-124.
16. Pereira H, Calé R, Pinto FJ, Pereira E, Caldeira D, Mello S, Vitorino S, Almeida MS, Mimoso J; centers participating in the Stent for Life Initiative Portugal. Factors influencing patient delay before primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: The Stent for life initiative in Portugal. Rev Port Cardiol (Engl Ed) 2018;37:409-421.
17. Ericsson M, Thylén I, Strömberg A, Ängerud KH, Moser DK, Sederholm Lawesson S. Factors associated with patient decision time in ST-segment elevation myocardial infarction, in early and late responders-an observational cross-sectional survey study. Eur J Cardiovasc Nurs 2022;21:694-701.
18. Shi O, Khan AM, Rezai MR, Jackevicius CA, Cox J, Atzema CL, Ko DT, Stukel TA, Lambert LJ, Natarajan MK, Zheng ZJ, Tu JV. Factors associated with door-in to door-out delays among ST-segment elevation myocardial infarction (STEMI) patients transferred for primary percutaneous coronary intervention: a population-based cohort study in Ontario, Canada. BMC Cardiovasc Disord 2018;18:204.
19. Sim WJ, Ang AS, Tan MC, Xiang WW, Foo D, Loh KK, Jafary FH, Watson TJ, Ong PJL, Ho HH. Causes of delay in door-to-balloon time in south-east Asian patients undergoing primary percutaneous coronary intervention. PLoS One 2017;12:e0185186.
20. Babiolakis CS, Sharma S, Sayed N, Abunassar JG, Haseeb S, Abuzeid W. The Effect of Sex on Door-to-Balloon Time in Patients Presenting With ST-Elevation Myocardial Infarction and Referred for Primary Percutaneous Coronary Intervention: A Systematic Review. Cardiovasc Revasc Med 2022;37:120-127.
21. Krishnan S V, Ravi M, Abraham SV, Palatty BU, Balakrishnan JM. Door to balloon time in patients presenting with acute ST elevation myocardial infarction and time factors influencing it; an observational study from a tertiary care teaching hospital in India. Indian Heart J 2021;73:359-361.
22. Martí D, Mestre JL, Salido L, Esteban MJ, Casas E, Pey J, Sanmartín M, Hernández-Antolín R, Zamorano JL. Incidence, angiographic features and outcomes of patients presenting with subtle ST-elevation myocardial infarction. Am Heart J 2014;168:884-890.
2. Canto JG, Kiefe CI, Rogers WJ, Peterson ED, Frederick PD, French WJ, Gibson CM, Pollack CV Jr, Ornato JP, Zalenski RJ, Penney J, Tiefenbrunn AJ, Greenland P; NRMI Investigators. Number of coronary heart disease risk factors and mortality in patients with first myocardial infarction. JAMA. 2011;306:2120-2127.
3. Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, Barengo NC, Beaton AZ, Benjamin EJ, Benziger CP, Bonny A, Brauer M, Brodmann M, Cahill TJ, Carapetis J, Catapano AL, Chugh SS, Cooper LT, Coresh J, Criqui M, DeCleene N, Eagle KA, Emmons-Bell S, Feigin VL, Fernández-Solà J, Fowkes G, Gakidou E, Grundy SM, He FJ, Howard G, Hu F, Inker L, Karthikeyan G, Kassebaum N, Koroshetz W, Lavie C, Lloyd-Jones D, Lu HS, Mirijello A, Temesgen AM, Mokdad A, Moran AE, Muntner P, Narula J, Neal B, Ntsekhe M, Moraes de Oliveira G, Otto C, Owolabi M, Pratt M, Rajagopalan S, Reitsma M, Ribeiro ALP, Rigotti N, Rodgers A, Sable C, Shakil S, Sliwa-Hahnle K, Stark B, Sundström J, Timpel P, Tleyjeh IM, Valgimigli M, Vos T, Whelton PK, Yacoub M, Zuhlke L, Murray C, Fuster V; GBD-NHLBI-JACC Global Burden of Cardiovascular Diseases Writing Group. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study. J Am Coll Cardiol 2020;76:2982-3021.
4. GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020;396:1204-1222.
5. O'Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013;61:e78-e140.
6. Li L, Wu MY, Zhang F, Li SF, Cui YX, Hu D, Chen H. Perspective of delay in door-to-balloon time among Asian population. J Geriatr Cardiol 2018;15:732-737.
7. Park JH, Ahn KO, Shin SD, Cha WC, Ryoo HW, Ro YS, Kim T. The first-door-to-balloon time delay in STEMI patients undergoing interhospital transfer. Am J Emerg Med 2016;34:767-771.
8. Kuno T, Kohsaka S, Numasawa Y, Ueda I, Suzuki M, Nakamura I, Negishi K, Ishikawa S, Maekawa Y, Kawamura A, Miyata H, Fukuda K. 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). Am J Cardiol 2015;115:581-586.
9. Dhungel S, Malla R, Adhikari C, Maskey A, Rajbhandari R, Sharma R, Nepal H, Rauniyar B, Yadav D, Limbu D, Gautam M, Adhikari A, Dhungel S, Upadhyay H. Door-to-balloon time and the determining factors in a tertiary cardiac center in Nepal. Indian Heart J 2018;70 Suppl 3(Suppl 3):S309-S312.
10. Shahin M, Obeid S, Hamed L, Templin C, Gamperli O, Nietlispach F, Maier W, Yousif N, Mach F, Roffi M, Windecker S, Raber L, Matter CM, Luscher TF. Occurrence and Impact of Time Delay to Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction. Cardiol Res 2017;8:190-198.
11. Foo CY, Bonsu KO, Nallamothu BK, Reid CM, Dhippayom T, Reidpath DD, Chaiyakunapruk N. Coronary intervention door-to-balloon time and outcomes in ST-elevation myocardial infarction: a meta-analysis. Heart 2018;104:1362-1369.
12. Park YH, Kang GH, Song BG, Chun WJ, Lee JH, Hwang SY, Oh JH, Park K, Kim YD. Factors related to prehospital time delay in acute ST-segment elevation myocardial infarction. J Korean Med Sci 2012;27:864-869.
13. Swaminathan RV, Wang TY, Kaltenbach LA, Kim LK, Minutello RM, Bergman G, Wong SC, Feldman DN. Nonsystem reasons for delay in door-to-balloon time and associated in-hospital mortality: a report from the National Cardiovascular Data Registry. J Am Coll Cardiol 2013;61:1688-1695.
14. Redfors B, Mohebi R, Giustino G, Chen S, Selker HP, Thiele H, Patel MR, Udelson JE, Ohman EM, Eitel I, Granger CB, Maehara A, Ali ZA, Ben-Yehuda O, Stone GW. Time Delay, Infarct Size, and Microvascular Obstruction After Primary Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction. Circ Cardiovasc Interv 2021;14:e009879.
15. Varcoe RW, Clayton TC, Gray HH, de Belder MA, Ludman PF, Henderson RA; British Cardiovascular Intervention Society (BCIS) and the National Institute for Cardiovascular Outcomes Research (NICOR). Impact of call-to-balloon time on 30-day mortality in contemporary practice. Heart 2017;103:117-124.
16. Pereira H, Calé R, Pinto FJ, Pereira E, Caldeira D, Mello S, Vitorino S, Almeida MS, Mimoso J; centers participating in the Stent for Life Initiative Portugal. Factors influencing patient delay before primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: The Stent for life initiative in Portugal. Rev Port Cardiol (Engl Ed) 2018;37:409-421.
17. Ericsson M, Thylén I, Strömberg A, Ängerud KH, Moser DK, Sederholm Lawesson S. Factors associated with patient decision time in ST-segment elevation myocardial infarction, in early and late responders-an observational cross-sectional survey study. Eur J Cardiovasc Nurs 2022;21:694-701.
18. Shi O, Khan AM, Rezai MR, Jackevicius CA, Cox J, Atzema CL, Ko DT, Stukel TA, Lambert LJ, Natarajan MK, Zheng ZJ, Tu JV. Factors associated with door-in to door-out delays among ST-segment elevation myocardial infarction (STEMI) patients transferred for primary percutaneous coronary intervention: a population-based cohort study in Ontario, Canada. BMC Cardiovasc Disord 2018;18:204.
19. Sim WJ, Ang AS, Tan MC, Xiang WW, Foo D, Loh KK, Jafary FH, Watson TJ, Ong PJL, Ho HH. Causes of delay in door-to-balloon time in south-east Asian patients undergoing primary percutaneous coronary intervention. PLoS One 2017;12:e0185186.
20. Babiolakis CS, Sharma S, Sayed N, Abunassar JG, Haseeb S, Abuzeid W. The Effect of Sex on Door-to-Balloon Time in Patients Presenting With ST-Elevation Myocardial Infarction and Referred for Primary Percutaneous Coronary Intervention: A Systematic Review. Cardiovasc Revasc Med 2022;37:120-127.
21. Krishnan S V, Ravi M, Abraham SV, Palatty BU, Balakrishnan JM. Door to balloon time in patients presenting with acute ST elevation myocardial infarction and time factors influencing it; an observational study from a tertiary care teaching hospital in India. Indian Heart J 2021;73:359-361.
22. Martí D, Mestre JL, Salido L, Esteban MJ, Casas E, Pey J, Sanmartín M, Hernández-Antolín R, Zamorano JL. Incidence, angiographic features and outcomes of patients presenting with subtle ST-elevation myocardial infarction. Am Heart J 2014;168:884-890.
| Files | ||
| Issue | Vol 18 No 1 (2023): J Teh Univ Heart Ctr | |
| Section | Brief Report | |
| DOI | https://doi.org/10.18502/jthc.v18i1.12584 | |
| Keywords | ||
| ST-elevation myocardial infarction; Door-to-treatment time Percutaneous coronary intervention | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Emami M, Mirzamohamadi S, Heidari A, Aein A, Salarifar M, Nematipour E. Evaluation of the Causes of Door-to-Balloon Time Delays in Patients with ST-Elevation Myocardial Infarction at Tehran Heart Center. J Tehran Heart Cent. 2023;18(1):68-71.
