IMPACT OF DOOR TO BALLOON TIME ON CLINICAL OUTCOME IN PATIENTS UNDERGOING PPCI

Main Article Content

Hassan Ali
Tariq Nawaz
Muhammad Amin
Sadam Hussain
Wasim Sajjad

Keywords

myocardial infarction, door-to-balloon, PPCI

Abstract

Background: The interval of time between an individual's visit to the hospital until PCI is beginning to unblock the obstructed artery and start blood flow again is known as the door-to-balloon time.it is very important method for MI care.


 


Objective: The current study was carried out to determine the Impact of Door to Balloon time on clinical outcome in patients undergoing PPCI. 


Material and method; this prospective observational study was conducted at the department of cardiology Lady reading hospital Peshawar from January 2022 to December 2023 after taking approval from the ethical committee of the institute. The study's sample size consisted of 94 primary PCI individuals that were treated at institute of cardiology during the duration of the research. Patients diagnosed with acute ST-segment elevation myocardial infarction (STEMI) who received primary PCI at department of cardiology during study period were included while Individuals lacking complete or missing medical records were excluded.  Majority of the patients were male (70%). Information of each individual was carefully gathered from a variety of sources, including patient files, angiogram results, and internal medicine records. SPSS version 21.0 software was utilized to do the statistical analysis. Descriptive statistics were used to summarize the patient demographics, clinical outcomes, and presentation time. 


Results: A total of 94 primary PPCI cases were included. Most of the patients Were in the 50–60 age group. Hypertension was the most predominant risk factor 40(42.5%) followed by diabetes 25(26.5%), smoking 14(14.8), family history 12(12.7) and hyperlipidemia 3(3.1%). Anterior ST segment elevation myocardial infarction (STEMI) was most prevalent in the study population(63%).The majority of the participants  (80%) only underwent PCI While 20% of the patients were given the recommendation to have a bypass after PCI of the infarct-related artery. Concerning the role of the culprit vessel, the most obstructed arterial was the left anterior descending artery, with 60 cases. 3.1 ± 0.6 mm was the mean stent diameter and 17.0 ± 8.0 mm the mean stent length. 1.38 was the average number of stents utilized per methodology and 18 minutes were the total average duration of the procedure. However, the total death rate was 4 (4.25%), which only comprised one person from the no delay group. Because of myocardial issues such cardiogenic shock, pulmonary edema, heart failure, and other mechanical issues, the remaining % is attributed to the delayed time group. In the delayed door-to-balloon time group, the mortality rate is around 30 percent. It was 1.5% for the group that arrived on time. 


Conclusion: Treatment for an acute myocardial infarction depends on the door-to-balloon time, which is significant in developing countries like Pakistan. Enhancing patient outcomes may be achieved via sponsoring emergency services, public health instruction, and healthcare infrastructure.

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References

1. Prior P, Gray WA. The remnant of our success. Catheterization Cardiovasc Interventions. 2021;97(6):1118–1119.
2. Nissen S, Brush J, Krumholz H. President’s page: gap-d2b: an alliance for quality. J Am Coll Cardiol. 2006; 48(9):1911–1912. jacc.2006.10.011
3. Tucker B, Patel S. Acute Coronary Syndrome: unravelling the Biology to Identify New Therapies. Cells. 2022;11(24):4136.
4. Fu R, Song C, Dou K, et al. Differences in symptoms and pre-hospital delay among acute myocardial infarction patients according to st-segment elevation on electrocardiogram. Chine Med J. 2019;132(5):519–524.
5. Bradley E, Herrin J, Wang Y, et al. Strategies for reducing the door-to-balloon time in acute myocardial infarction. N Engl J Med. 2006;355 (22):2308–2320.
6. Kong P, Connolly D, Varma C, et al. High-risk myocardial infarction patients appear to derive more mortality benefit from short door-to-balloon time than low-risk patients. Int J Clin. 2009;63(12):1693–1701.
7. Kumar V, Prabhu SD, Bansal SS. CD4+ T-lymphocytes exhibit biphasic kinetics post-myocardial infarction.Front Cardiovascular Med. 2022;9:992653.
8. Zhou Y, Yuan J, Fan Y, et al. Proteomic landscape of human coronary artery atherosclerosis. IntJ Mol Med. 2020;46(1):371–383.
9. Chen F, Lin Y, Kung C, Cheng C, Li C. The association between door-to-balloon time of less than 60 minutes and prognosis of patients developing st segment elevation myocardial infarction and undergoing primary percutaneous coronary intervention. Bi. BioMed Res Int. 2017;2017:1–6.
10. Denktas AE, Anderson HV, McCarthy J, Smalling RW. Total ischemic time: the correct focus of attention for optimal ST-segment elevation myocardial infarction care. JACC Cardiovasc Interv. 2011;4(6):599–604.
11. McCabe JM, Kennedy KF, Eisenhauer AC, et al. Reporting trends and outcomes in ST-segment–elevation myocardial infarction national hospital quality assessment programs.Circulation. 2014; 129(2):194–202.
12. Wachira BW, Owuor AO, Otieno HA. Acute management of ST-elevation myocardial infarction in a tertiary hospital in Kenya: are we complying with practice guidelines? Phase active de prise en charge des infarctus du myocarde avec élévation du segment ST dan. Af J Em Med. 2014;4(3):104.
13. Vavalle JP, Granger CB. The need for regional integrated care for ST-segment elevation myocardial infarction. Circulation. 2011;124(7):851–856.
14. Stassen W, Wallis L, Vincent-Lambert C, Castren M, Kurland L. The proportion of South Africans living within 60 and 120 minutes of a percutaneous coronary intervention facility. Cardiovascular J Africa. 2018;29(1):6–11.
15. Cannon CP. Relationship of symptom-onset-to-balloon time and door-to-balloon time with mortality in patients undergoing angioplasty for acute myocardial infarction. JAMA. 2000; 283(22):2941.
16. Nozari Y, Geraiely B, Alipasandi K, et al. Time to treatment and in-hospital major adverse cardiac events among patients with st-segment elevation myocardial infarction who underwent primary percutaneous coronary int. JMIR Res Protocols. 2019;8(3):e13161.
17. Gadre A, Kotaru V, Mehta A, Kumar D, Rayasam V. Delayed presentation during covid-19 pandemic leading to post-myocardial infarction ventricular septal defect. Cureus. 2021.
18. Rathore SS, Curtis JP, Nallamothu BK, et al. Association of door-to-balloon time and mortality in patients≥ 65 years with ST-elevation myocardial infarction undergoing primary percutaneous coro. Am J Cardiol. 2009; 104(9):1198–1203.
19. Hassan MO, Ahmed SA, Hassan MS, Mohamud MA, Abdi AE. Exploring Myocardial Infarction Knowledge, Attitudes, and Practice among Mogadishu’s Somali Residents. Vasc Health Risk Manag. 2024; 20:13–20.