Key result
Door-to-balloon time ≤ 90 minutes significantly reduced 30-day mortality in STEMI patients with Killip ≥ 2 (OR 0.56), but did not significantly affect mortality in patients with Killip 1.
Why the study?
Does door-to-balloon time ≤ 90 minutes reduce 30-day mortality in STEMI patients stratified by Killip classification?
Observational (n=1,127)
Yes
Does door-to-balloon time ≤ 90 minutes reduce 30-day mortality in STEMI patients stratified by Killip classification?
Odds Ratio: 0.56 (95% CI 0.32–0.99)
Absolute Event Rate: 13.3% vs 22.8%
p-value: p=<0.05
Shortening door-to-balloon time to ≤ 90 minutes significantly improves 30-day mortality in STEMI patients presenting with Killip class ≥ 2, but may not have the same prognostic impact in those with Killip class 1.
May support expedited reperfusion in Killip ≥2 STEMI; leaves open Killip-stratified DBT targets pending prospective confirmation.
The coronavirus disease 2019 pandemic occurred in several countries, making the conventional medical system difficult to maintain. Recent recommendations aim to prevent nosocomial infections and infections among health care workers. Therefore, establishing a cardiovascular medical system under an emergency for patients with ST-segment elevation myocardial infarction (STEMI) is desired. This study aimed to determine the relationship between prognosis and door-to-balloon time (DBT) shortening based on the severity on arrival.This retrospective, multi-center, observational study included 1,127 consecutive patients with STEMI. These patients were transported by emergency medical services and underwent primary percutaneous coronary intervention. Patients were stratified according to the Killip classification: Killip 1 (n = 738) and Killip ≥ 2 (n = 389) groups.Patients in the Killip ≥ 2 group were older, with more females, and more severity on arrival than those in the Killip 1 group. The 30-day mortality rate in the Killip 1 and Killip ≥ 2 groups was 2.2% and 18.0%, respectively. The Killip ≥ 2 group had a significant difference in the 30-day mortality between patients with DBT ≤ 90 minutes and those with DBT > 90 minutes; however, this did not occur in the Killip 1 group. Furthermore, multivariate analysis revealed that DBT ≤ 90 minutes was not a significant predictive factor in the Killip 1 group; however, it was an independent predictive factor in the Killip ≥ 2 group.DBT shortening affected the 30-day mortality in STEMI patients with Killip ≥ 2, although not those with Killip 1.
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Sakamoto et al. (2022) conducted an observational in ST-Segment Elevation Myocardial Infarction (STEMI) (n=1,127). Door-to-balloon time ≤ 90 minutes vs. Door-to-balloon time > 90 minutes was evaluated on 30-day mortality in patients with Killip ≥ 2 (OR 0.56, 95% CI 0.32-0.99, p=<0.05). Door-to-balloon time ≤ 90 minutes significantly reduced 30-day mortality in STEMI patients with Killip ≥ 2 (OR 0.56), but did not significantly affect mortality in patients with Killip 1.
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