Key result
Presentation with STEMI-equivalent ECGs was an independent predictor of delayed door-to-balloon time >90 min compared to typical STEMI (OR 4.692; 95% CI 1.632-13.490; p=0.004).
Why the study?
Longer door-to-balloon time is associated with unfavorable outcomes in STEMI undergoing primary PCI, but it was unknown whether door-to-balloon time is delayed in patients presenting with STEMI-equivalent ECGs.
Does presentation with a STEMI-equivalent ECG delay door-to-balloon time compared to classic STEMI ECG in patients undergoing primary PCI?
Observational (n=180)
Does presentation with a STEMI-equivalent ECG delay door-to-balloon time compared to classic STEMI ECG in patients undergoing primary PCI?
Patients presenting with STEMI-equivalent ECGs experience significantly longer door-to-balloon times compared to those with classic STEMI, highlighting a need for improved rapid recognition by emergency and interventional teams.
STEMI-equivalent ECGs were associated with delayed door-to-balloon time; hypothesis-generating for targeted recognition protocols before practice change.
Background: In patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary interventions (pPCI), longer door-to-balloon (DTB) time is known to be associated with an unfavorable outcome. A percentage of patients with acute coronary occlusion present with atypical electrocardiographic (ECG) findings, known as STEMI-equivalents. We investigated whether DTB time for STEMI-equivalent patients was delayed. Methods: This is a retrospective study including patients arriving at an emergency department with the acute coronary syndrome in whom emergent pPCI was performed. ECGs were classified into STEMI and STEMI-equivalent groups. We compared DTB time, with its components, between the groups. We also investigated whether STEMI-equivalent ECG was an independent predictor of DTB time delayed for more than 90 min. Results: A total of 180 patients were included in the present study, and 23 patients (12.8%) presented with STEMI-equivalent ECGs. DTB time was significantly delayed in patients with STEMI-equivalent ECGs (89 (80–122) vs. 81 (70–88) min, p = 0.001). Multivariable logistic regression analysis showed that STEMI-equivalent ECG was an independent predictor of delayed DTB time (odds ratio: 4.692; 95% confidence interval: 1.632–13.490, p = 0.004). Conclusions: DTB time was significantly delayed in patients presenting with STEMI-equivalent ECGs. Prompt recognition of STEMI-equivalent ECGs by emergency physicians and interventional cardiologists might reduce DTB time and lead to a better clinical outcome.
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Choi et al. (2022) conducted an observational in Acute coronary syndrome (n=180). STEMI-equivalent ECG vs. STEMI ECG was evaluated on Delayed door-to-balloon (DTB) time >90 min (OR 4.692, 95% CI 1.632-13.490, p=0.004). Presentation with STEMI-equivalent ECGs was an independent predictor of delayed door-to-balloon time >90 min compared to typical STEMI (OR 4.692; 95% CI 1.632-13.490; p=0.004).
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