Causes of delay in door-to-balloon time in south-east Asian patients undergoing primary percutaneous coronary intervention

• Published in: PloS one Vol. 12; no. 9; p. e0185186
• Main Authors: Sim, Wen Jun, Ang, An Shing, Tan, Mae Chyi, Xiang, Wen Wei, Foo, David, Loh, Kwok Kong, Jafary, Fahim Haider, Watson, Timothy James, Ong, Paul Jau Lueng, Ho, Hee Hwa
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 21.09.2017; Public Library of Science (PLoS)
• Subjects: Analysis; Angioplasty; Asian Continental Ancestry Group; Balloon angioplasty; Balloon treatment; Biology and Life Sciences; Cardiology; Clinical outcomes; Computed tomography; Coronary Angiography; Delay; Electrocardiography; Emergency medical care; Emergency medical services; Female; Heart attacks; Hospitals; Hospitals - statistics & numerical data; Humans; Incidence; Intervention; Laboratories; Male; Medicine and Health Sciences; Middle Aged; Mortality; Myocardial infarction; Patients; People and Places; Percutaneous Coronary Intervention - methods; Research and Analysis Methods; Retrospective Studies; ST Elevation Myocardial Infarction - diagnostic imaging; ST Elevation Myocardial Infarction - surgery; Studies; Time Factors; Time measurement; Treatment Outcome; Singapore
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0185186

To evaluate causes and impact of delay in the door-to-balloon (D2B) time for patients undergoing primary percutaneous coronary intervention (PPCI). From January 2009 to December 2012, 1268 patients (86% male, mean age of 58 ± 12 years) presented to our hospital for ST-elevation myocardial infarction (STEMI) and underwent PPCI. They were divided into two groups: Non-delay defined as D2B time ≤ 90 mins and delay group defined as D2B time > 90 mins. Data were collected retrospectively on baseline clinical characteristics, mode of presentation, angiographic findings, therapeutic modality and inhospital outcome. 202 patients had delay in D2B time. There were more female patients in the delay group. They were older and tend to self-present to hospital. They were less likely to be smokers and have a higher prevalence of prior MI. The incidence of posterior MI was higher in the delay group. They also had a higher incidence of triple vessel disease. The 3 most common reasons for D2B delay was delay in the emergency department (39%), atypical clinical presentation (37.6%) and unstable medical condition requiring stabilisation/computed tomographic imaging (26.7%). The inhospital mortality was numerically higher in the delay group (7.4% versus 4.8%, p = 0.12). Delay in D2B occurred in 16% of our patients undergoing PPCI. Several key factors for delay were identified and warrant further intervention.