Factors associated with poor clinical outcomes of ST-elevation myocardial infarction in patients with door-to-balloon time <90 minutes

• Published in: PloS one Vol. 15; no. 10; p. e0241251
• Main Authors: Tsukui, Takunori, Sakakura, Kenichi, Taniguchi, Yousuke, Yamamoto, Kei, Seguchi, Masaru, Jinnouchi, Hiroyuki, Wada, Hiroshi, Fujita, Hideo
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 22.10.2020; Public Library of Science (PLoS)
• Subjects: Age; Aged; Aged, 80 and over; Angiography; Angioplasty, Balloon, Coronary; Balloon treatment; Biology and Life Sciences; Blood clots; Blood pressure; Body mass; Body mass index; Body size; Care and treatment; Catheters; Cholesterol; Clinical outcomes; Congestive heart failure; Diabetes; Emergency medical care; Engineering and Technology; Female; Health hazards; Heart attack; Heart attacks; Heart failure; Hospitalization; Hospitals; Humans; Hypertension; Laboratories; Male; Medical imaging; Medical treatment; Medicine; Medicine and Health Sciences; Middle Aged; Multivariate Analysis; Myocardial infarction; Patient outcomes; Patients; Proportional Hazards Models; Risk Factors; ST Elevation Myocardial Infarction - diagnostic imaging; ST Elevation Myocardial Infarction - surgery; Time Factors; Treatment Outcome; Variables; Japan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0241251

Recent guidelines for ST-elevation myocardial infarction (STEMI) recommended the door-to-balloon time (DTBT) <90 minutes. However, some patients could have poor clinical outcomes in spite of DTBT <90 minutes, which suggest the importance of therapeutic targets except DTBT. The purpose of this study was to find factors associated with poor clinical outcomes in STEMI patients with DTBT <90 minutes. This retrospective study included 383 STEMI patients with DTBT <90 minutes. The primary endpoint was the major adverse cardiac events (MACE) defined as the composite of all-cause death, acute myocardial infarction, and acute heart failure requiring hospitalization. The median follow-up duration was 281 days, and the cumulative incidence of MACE was 16.2%. In the multivariate Cox hazard model, low body mass index (< 20 kg/m2) (vs. >20 kg/m2: HR 2.80, 95% CI 1.39-5.64, p = 0.004), history of previous myocardial infarction (HR 2.39, 95% CI 1.06-5.37, p = 0.04), and Killip class 3 or 4 (vs. Killip class 1 or 2: HR 2.39, 95% CI 1.30-4.40, p = 0.005) were significantly associated with MACE. In another multivariate Cox hazard model, flow worsening during percutaneous coronary intervention (PCI) (HR 3.24, 95% CI 1.79-5.86, p<0.001) and use of mechanical support (HR 3.15, 95% CI 1.71-5.79, p<0.001) were significantly associated with MACE, whereas radial approach (HR 0.54, 95% CI 0.32-0.92, p = 0.02) was inversely associated with MACE. Low body mass index, Killip class 3/4, history of previous myocardial infarction, use of mechanical support, and flow worsening were significantly associated with MACE, whereas radial-access was inversely associated with MACE. It is important to avoid flow worsening during primary PCI even when appropriate DTBT was achieved.