Reduction of door‐to‐balloon time in patients with ST‐elevation myocardial infarction by single‐catheter primary percutaneous coronary intervention method

Figures

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  Figure 1. Single‐catheter primary percutaneous coronary intervention (SC‐PCI) method and conventional methods. In primary percutaneous coronary intervention (PCI), coronary angiography is performed first. In SC‐PCI method, an Ikari left curve is used as a diagnostic catheter both for left and right coronary arteries and a guiding catheter to perform PCI. In the conventional methods, initial diagnostic angiography was performed using diagnostic catheters. These can be done in several ways; Conventional method #1) using the Judkins R and Judkins L diagnostic catheters, Conventional method #2) using a diagnostic catheter to contrast the contralateral side of the culprit artery and a guiding catheter to contrast the culprit artery, or Conventional method #3) using a universal diagnostic catheter (TIG, Mitsudo etc.) to contrast both sides and then change to a guiding catheter. The SC‐PCI method can skip several steps; five steps compared with the conventional method #1 as two catheter insertions, two catheter removals, and one engagement to the coronary artery, two steps compared with conventional method #2, or three steps compared with conventional method #3

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  Figure 2. Door‐to‐balloon time (D2B). The D2B time was significantly shorter in the single catheter primary percutaneous coronary intervention (SC‐PCI) method group (68 ± 46 vs. 76 ± 51 min, respectively; p = .02) than in the conventional method group. When the D2B time is divided into door‐to‐sheath (D2S) time and sheath‐to‐balloon (S2B) time, the S2B time was significantly different (19 ± 14 vs. 23 ± 14 min, respectively; p < .0001), but the D2S time was not significantly different (49 ± 42 vs. 53 ± 46 min, respectively; p = .18) [Color figure can be viewed at wileyonlinelibrary.com]

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  Figure 3. Radiation exposure dose and fluorescent time. (A) Radiation exposure dose and (B) fluorescent time [Color figure can be viewed at wileyonlinelibrary.com]

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  Figure 4. Analysis of sheath‐to‐balloon time by institute. Reduced sheath‐to‐balloon time with the single catheter primary percutaneous coronary intervention (SC‐PCI) method was analyzed separately for each institution. For this analysis, we used data from ten institutes, where at least five cases of the SC‐PCI method were enrolled. The sheath‐to‐balloon time in the SC‐PCI method was shorter in 90% of institutes, and the difference was statistically significant in 80%