To Shorten The "Door-to-balloon Time" On Patients With STEMI Impact On Short-term Prognosis

AMI is an important cause of death, which is usually caused by coronary atherosclerotic plaque rupture , activation and aggregation of platelet and following thrombosis formation. The rapid reestablishing coronary artery flow of the infarct-related coronary artery (infarct: related coronary, IRA) should be the key point of the treatment of AMI. [1-5] That is to say , prompt reperfusion therapy should be performed as quickly as possible . Primary PCI is one of the most important methods of rapid reperfusion of IRA ,which can limit myocardial necrosis efficiently.The guidelines of ACC and ESC both recommend that primary PCI performed by proper operator should be the preferred reperfusion strategy in those hospitals that have the proper conditions ,and the D-to-B should be less than 90 mins . The D-to-B refers to the time from the entrance to the hospital to the balloon dilatation.It is a life-saving clinical practice recently launched by the American Heart Association, which is intended to shorten the delay of emergency percutaneous coronary intervention in patients [12]. Considered that the survival rate of the patients who are treated with primary PCI is closely related to the beginning time of treatment,all guidelines recommend 90 mins as a new gold standard. [9] Objective: To analyse the safety and efficacy of PCI in 78 STEMI patients with different time door-to-balloon time, and to explore the possibility of shortening the door-to-balloon time.Methods: Total of 78 patients (admitted to our hospital from January 2007 to January 2009 ,65 males ,13 females ,aged aged from 32-year-old to 80-year-old )with STEMI who were treated with concurrent emergency PCI were divided into two groups: group A contains 35 cases whose D-to-B≤90 minutes, group B contains 43 cases with 90 minutes < D-to-B≤120 minutes . Heart function , TIMI flow to resume, ST-T segment dropped index, intraoperative complications, postoperative angina attack, the number of days hospitalized difference are compared.Results:1.The basic clinical characteristics of the two groups are similar.2. In the total 78 cases of acute ST-segment elevation myocardial infarction treated with primary PCI 73 cases acheived TIMI-Ⅲlevel flow, the success rate was 93.6%, reperfusion arrhythmia appears in 21 cases during the operation,and recovered after treatment.other patients without new occlusion, the symptoms relief within 1-5 h after, return to normal within 24h.Examination of indicators were compared as following: A group of D-to-B≤90 minutes and B group 90 minutes < D-to-B≤120 minutes after the rate of TIMI-Ⅲlevel, LVEF and ST - T decline rate above comparison, the postoperative rate of TIMI-Ⅲgrade A was significantly higher than the B group 34/35 (97.1%): 39/43 (90.7%) p <0.05. Group A contained one case of slow flow phenomenon ,while B group contains 3 cases of slow flow and 1 case of no-reflow phenomenon. ST segment decline rate (> 50%): A group of full-ST down after the infarct-related leads was significantly higher than the B group 32/35 (91.4%): 28/43 (65.1%) (P <0.05). LVEF left ventricular function of the group A and group B were compared as 58.48±11.82%: 50±10.58%, p <0.05, with a significant difference.3. Comparison of Clinical Indicators: A group (D-to-B≤90 minutes )and B group( 90 minutes < D-to-B≤120 minutes )of intraoperative and postoperative complications compared: the emergence of reperfusion arrhythmias and blood pressure decreasing 13/35 (37.1%): 8 / 43 (18.6%). Angina pectoris after 2 / 35 (5.7%): 6 / 43 (13.9%), length of hospital stay 8.23±5.04:11.50±6.25 (p <0.05),4. The two groups no longer re-infarction during hospitalization occurred, no surgery-related complications and all were to alleviate chest pain symptoms.Conclusion:1. D-to-B for 90 minutes or less in heart function, TIMI flow to resume, ST-T segment dropped index, intraoperative complications, postoperative angina attack, the number of days hospitalized difference were better than the D-to-B over 90 minutes Group2. For all STEMI patients D-to-B should be as short as possible;3. D-to-B should be less than 90min and achieve the 90min's gold standard ;4. A green channel should be established in every proper hospitals for patients suffered from AMI.