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Association between Coronary Collaterals and Myocardial Viability in Patients with a Chronic Total Occlusion Effects of clopidogrel vs. prasugrel vs. ticagrelor on endothelial function, inflammatory parameters, and platelet function in patients with acute coronary syndrome undergoing coronary artery stenting: a randomized, blinded, parallel study Acute Coronary Syndrome Following Transcatheter Aortic Valve Replacement Global Chronic Total Occlusion Crossing Algorithm: JACC State-of-the-Art Review Myocardial infarction with non-obstructive coronary arteries as compared with myocardial infarction and obstructive coronary disease: outcomes in a Medicare population Optimal medical therapy vs. coronary revascularization for patients presenting with chronic total occlusion: A meta-analysis of randomized controlled trials and propensity score adjusted studies Post-Discharge Bleeding and Mortality Following Acute Coronary Syndromes With or Without PCI Morphine and Cardiovascular Outcomes Among Patients With Non-ST-Segment Elevation Acute Coronary Syndromes Undergoing Coronary Angiography Multivessel Versus Culprit-Vessel Percutaneous Coronary Intervention in Cardiogenic Shock Switching P2Y12-receptor inhibitors in patients with coronary artery disease
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Original Research2014 Jul 1;114(1):24-8.

JOURNAL：Am J Cardiol. Article Link

Frequency of nonsystem delays in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention and implications for door-to-balloon time reporting (from the American Heart Association Mission: Lifeline program)

Cotoni DA1, Roe MT, Kontos MC et al. Keywords: ST-elevation myocardial infarction; primary percutaneous coronary intervention; door-to-balloon time

ABSTRACT

The percentage of patients with primary percutaneous coronary intervention (PCI) with door-to-balloon (D2B) times ≤90 minutes is used as a hospital performance measure for public reporting. Patients can be excluded from reporting for nonsystem-related delays. How exclusions impact D2B time reporting at the hospital level is unknown. The percentage of patients having nonsystem delays for primary PCI at the hospital level was calculated using data from the Acute Coronary Treatment Intervention Outcomes Network Registry-Get with the Guidelines Registry. Hospitals were categorized based on tertiles of percentage of excluded patients: low, ≤7.1%; intermediate, >7.1% to 11.2%; and high, >11.2%. From January 1, 2007, to March 31, 2011, 43,909 patients from 294 hospitals were included. The percentage of exclusions differed substantially among hospitals (0% to 68%, median 9.2% [interquartile range 5.6% to 13.5%]). Exclusion reasons included vascular access difficulty (7.6%), cardiac arrest/intubation (38%), and PCI procedural difficulties (20%). Including patients with nonsystem delays significantly increased D2B times by ≤2 minutes for each group. The effect was larger on the proportion of patients having a D2B ≤90 minutes (low 83.6% to 85%, intermediate 82.9% to 86.3%, high 82% to 87.5%, p <0.001, for all). If a criterion of having ≥90% of patients with D2B ≤90 minutes was used, excluding patients with nonsystem delays significantly increased the proportion of patients meeting this goal for each group: low, 28% to 37%; intermediate, 17.7% to 37.5%; and high, 14% to 52% (all p <0.01). In conclusion, the proportion of patients excluded from D2B reporting varies substantially among hospitals. This has a greater impact on percentage of patients with D2B time ≤90 minutes than on median D2B times.
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