Author + information
- S1936879815021068-f2fba11771803d19febae944f1783e96Smita I. Negi,
- S1936879815021068-04922536d0743a257a0e4850a20bd531Romain Didier,
- S1936879815021068-df3d3811d4aa66f4c269691e45bf8affNirav Patel,
- S1936879815021068-22ca6bb575feb9b0401e73b8ef13bd3aSarkis Kiramijyan,
- S1936879815021068-0e824b6bd196b6c074117d96f588e1f3Edward Koifman,
- S1936879815021068-bb7d56defc47dfa50850f194a4d010d0Toby Rogers,
- S1936879815021068-b41fe52590ef8bb393cebb8b291037bfArie Steinvil,
- S1936879815021068-43188b297454714a1e633ce32956ff39Rebecca Torguson,
- S1936879815021068-280150bfca3f0be2b424079de79e87c6Itsik Ben Dor,
- S1936879815021068-6471d8c6fff02675299bdedf4d1b748fWilliam Suddath,
- S1936879815021068-e581276892d3eac6d775a41ed0644866Lowell Satler and
- S1936879815021068-772b1cb1fca98a9f26e1e7f8bddc725bRon Waksman
Current guidelines emphasize shorter door to balloon (D2B) times in patients presenting to Emergency Department with ST-segment elevation myocardial infarction (STEMI) and hospitals have primary percutaneous coronary intervention (p-PCI) protocols in place to achieve this goal. However, there remain subset of patients who present with symptoms of myocardial ischemia but develop STE not on presenting but subsequent ECG.
We aim to study the characteristics and impact on in hospital outcome of patients presenting with chest pain with STE on subsequent ECG leading to a prolonged (D2B) time.
Using a prospective registry of consecutive patients for whom the p-PCI protocol had been activated, we identified patients who had STE on subsequent ECG. For comparison, age and gender matched control group of patients with STEMI diagnosis on presenting ECG around the same time of presentation.
In total of 1050 patient for whom p-PCI protocol was activated, 26 had STE on subsequent ECG. Age and gender were well matched between cases and controls. Mean age was 60.5±15.5 years. D2B time was 193.25 ±17 minutes for cases while subsequent ECG to call time was 10.1± 9 minutes. Left anterior descending artery was the commonest culprit vessel among cases and right coronary in control group. 77% of cases and 72% of controls underwent p-PCI. There was no in-house mortality reported for either group. Both cases and controls had similar left ventricular ejection fractions at discharge and at 1-month follow up.
Despite longer D2B times in patients with STE on subsequent ECG, no significant difference was seen in the in final left ventricular systolic function and in hospital outcome when compared with patients with STE on arrival ECG.