Door-to-balloon time and cardiac mortality in acute myocardial infarction by total occlusion of the left circumflex artery. Issue 5 (August 2018)

• Record Type: Journal Article
• Authors: Kang, Min Gyu; Kim, Kyehwan; Park, Hyun Woong; Koh, Jin-Sin; Park, Jeong Rang; Hwang, Seok-Jae; Ahn, Jong-Hwa; Park, Yongwhi; Jeong, Young-Hoon; Kwak, Choong Hwan; Jeong, Myung Ho; Chae, Shung Chull; Kim, Hyo-Soo; Kim, Young Jo; Cho, Myeong Chan; Kim, Chong Jin; Hwang, Jin-Yong
• Is Part Of: Coronary artery disease. Volume 29:Issue 5(2018:Aug.)
• Publication Date: 2018-08
• Subjects: acute myocardial infarction -- cardiac mortality -- door-to-balloon time -- left circumflex artery -- total occlusion; Coronary heart disease -- Periodicals; Coronary Disease -- Indexes; Coronary Disease -- Periodicals; 616.123005
• DOI: 10.1097/MCA.0000000000000616
• Languages: English
• ISSNs: 0954-6928

Abstract

Abstract : Background: Acute myocardial infarction (AMI) caused by total occlusion of the left circumflex artery (LCX) can present as non-ST-segment elevation myocardial infarction (NSTEMI). We evaluate whether door-to-balloon time (DBT) is associated with cardiac mortality in patients with total occlusion of the LCX. Patients and methods: From the Korea Acute Myocardial Infarction Registry, patients with AMI who had total occlusion with a Thrombolysis In Myocardial Infarction flow grade of 0 were included. We determined the factors for delay in primary percutaneous coronary intervention (DBT>90 min) and evaluated cardiac mortality for a median period of 14 months. Results: Mean DBT was 68 min (interquartile range=50–156 min), and the achievement rate of DBT less than or equal to 90 min was 66.9% in the entire study population. More than half of patients with total occlusion of LCX were presented as NSTEMI (57.7%). Among patients with total occlusion of the LCX, the mean DBT was 136 min (interquartile range=60–484 min), and the achievement rate of DBT less than or equal to 90 min was 42.8%. On multivariate analysis, LCX occlusion was an important factor for DBT more than 90 min (odds ratio: 1.766, P <0.001). Among patients with LCX occlusion, cardiac mortality was higher in patients with ST-segment elevation (6.2 vs. 11.0%, P =0.024). Conclusion: This study showed that LCX occlusion was a significant factor for the delay in primary percutaneous coronary intervention on account of presenting as NSTEMI. Cardiac mortality was not associated with DBT more than 90 min but with ST-segment elevation in AMI patients with total occlusion of the LCX.