Key result
Prolonged D2B time links to ~57% higher in-hospital mortality exclusively in rural STEMI patients.
Why the study?
It is unclear whether regional disparities in the prognostic value of door-to-balloon time remain among STEMI patients in contemporary Japan.
Does rural versus urban location impact the prognostic significance of door-to-balloon time on in-hospital mortality in patients with STEMI?
Observational (n=17,167)
Yes
Does rural versus urban location impact the prognostic significance of door-to-balloon time on in-hospital mortality in patients with STEMI?
There is a substantial rural-urban gap in the prognostic significance of prolonged door-to-balloon time among STEMI patients in Japan, with prolonged times predicting in-hospital mortality only in rural areas, especially among those with cardiogenic shock.
Answers are grounded in this paper and cite their sources.
May warrant rural-specific D2B vigilance in STEMI; leaves open causal mechanisms and prospective validation of location-adjusted thresholds.
BACKGROUND: Although a door-to-balloon (D2B) time ≤90 min is recognized as a key indicator of timely reperfusion for patients with ST-segment elevation myocardial infarction (STEMI), it is unclear whether regional disparities in the prognostic value of D2B remain in contemporary Japan. METHODS AND Compared with the urban group, median D2B time was longer (70 vs. 62 min; P<0.001) and the rate of achieving a D2B time ≤90 min was lower (70.7% vs. 75.4%; P<0.001) in the rural group. In-hospital mortality was lower for patients with a D2B time ≤90 min than >90 min, regardless of residential area, whereas multivariable analysis identified prolonged D2B time as a predictor of in-hospital death only in the rural group (adjusted odds ratio 1.57; 95% confidence interval 1.18-2.09; P=0.002). Importantly, the rural-urban disparity in in-hospital mortality emerged most distinctively among patients with Killip Class IV and a D2B time >90 min. CONCLUSIONS: These data suggest that there is a substantial rural-urban gap in the prognostic significance of D2B time among STEMI patients, especially those with cardiogenic shock and a prolonged D2B time.
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Fukui et al. (2022) conducted an observational in ST-segment elevation myocardial infarction (n=17,167). Prolonged door-to-balloon time (>90 min) vs. Door-to-balloon time ≤90 min was evaluated on In-hospital mortality (OR 1.57, 95% CI 1.18-2.09, p=0.002). Prolonged door-to-balloon time (>90 min) was an independent predictor of in-hospital mortality only in rural areas (adjusted OR 1.57), especially among patients with cardiogenic shock.
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