Background: Prompt reperfusion treatment is essential for patients who have myocardial infarction with ST-segment elevation (STEMI).several strategies have been proposed to improve delays prior to catheterization laboratory(Cathlab) arrial, few recommendations have been made regarding optimal management of STEMI patients in the cathlab. The aim of this study was to compare door to balloon time(D2B) and cathlab door to balloons (C2B) of immediate culprit vessel percutaneous coronary intervention(PCI) as initial treatment to traditional complete coronary angiography followed by PCI for the treatment of STEMI patients.
Methods: consecutive STEMI patients undergoing primary PCI at our institution from January 2009 to August 2009 and who had complete door to balloon (D2B) time information available were included in this study. 2 groups were divided: the study group(group1) included patients who first underwent culprit PCI followed by complete coronary angiography. Control group(group2) consisted of patients who underwent PCI after a complete coronary angiogram. The primary evaluation was D2B time and C2B time. 30-day major adverse clinical events (MACE) were recorded and compared between the 2 groups.
Results: 168 patients were included in this study. 61 patients was in group 1 and 107 patients in Group 2. Procedural success was 100% in both groups. Door to vascular access times were similar for the 2 groups: 67.6 กพ 20.4minutes in group1 vesus 77.6 กพ 43.8 minutes in group2,p=0.09 . vascular access-to-balloon time was 9.1กพ3.4minutes in group1 vs. 18.1 กพ 6.6 minutes in group 2, p <0.001. Mean C2B time was 15.5กพ 4.2minutes in Group 1 and 25.8กพ 8.3 minutes in Group 2 (p < 0.001). mean DTB time was76.7 กพ20.4 minutes for patients in Group 1, compared to 96.8กพ44.1 minutes in Group 2 (p = 0.002). patients in group1 had a higher reperfusion rate(DTB < 90 min) than patients in group 2 (77.0% vs 57.9%, p = 0.002). The incidence of MACE was similar in the 2 groups:1.6% in group1 versus 1.9% in group 2 .
Conclusion: a new stratergy of immediate PCI of the culprit infarct-related for STEMI as initial treatment resulted in a decrease in theD2B and C2B time compared to traditional coronary angiography followed by PCI .
