Reduction of door-to-balloon time in patients with ST-elevation myocardial infarction by single-catheter primary percutaneous coronary intervention method

Abstract

Objectives: The objectives of this study is to confirm reduction of door-to-balloon (D2B) time with single-catheter percutaneous coronary intervention (SC-PCI) method.

Background: Reduction of total ischemic time is important in the emergency treatment of ST-elevation myocardial infarction (STEMI). There have been no established methods in primary percutaneous coronary intervention (PCI) to shorten ischemic time via radial access. Ikari left curve was reported as a universal guiding catheter for left and right coronary arteries. Several procedure steps can be skipped by SC-PCI method as the advantage of a universal catheter.

Methods: This study is a retrospective analysis of a total of 1,275 consecutive STEMI cases treated with primary PCI in 14 hospitals. Patients were divided into two groups, SC-PCI method (n = 298) and conventional PCI method (n = 977). Primary endpoints were door-to-balloon (D2B) time and radiation exposure dose.

Results: The mean age was 68 ± 13 years old. Radial access was used in 85% of participants. PCI success was achieved in 99.5% of participants and the SC-PCI method was successfully performed in 92.6%. The D2B time was shorter (68 ± 46 vs. 74 ± 50 min, respectively; p = .02), and the radiation exposure dose was lower (1,664 ± 970 vs. 2008 ± 1,605 mGy, respectively; p < .0001) in the SC-PCI group than in the conventional group.

Conclusion: Primary PCI with SC-PCI method for patients with STEMI demonstrated shorter D2B time and lower radiation exposure dose.

Keywords: Ikari catheter; radial access; radiation exposure.

Conflict of interest statement

Sho Torii received institutional research support from Boston Scientific Japan, honoraria from Boston Scientific Japan, Abbott vascular Japan, and Medtronic Japan. Yuji Ikari received a research grant from Boston Scientific and an inventor of the Ikari curve. The other authors have no conflicting interests to disclose.

© 2021 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.

Figures

Figure 1

Single‐catheter primary percutaneous coronary intervention (SC‐PCI) method and conventional methods. In primary percutaneous coronary intervention (PCI), coronary angiography is performed first. In SC‐PCI method, an Ikari left curve is used as a diagnostic catheter both for left and right coronary arteries and a guiding catheter to perform PCI. In the conventional methods, initial diagnostic angiography was performed using diagnostic catheters. These can be done in several ways; Conventional method #1) using the Judkins R and Judkins L diagnostic catheters, Conventional method #2) using a diagnostic catheter to contrast the contralateral side of the culprit artery and a guiding catheter to contrast the culprit artery, or Conventional method #3) using a universal diagnostic catheter (TIG, Mitsudo etc.) to contrast both sides and then change to a guiding catheter. The SC‐PCI method can skip several steps; five steps compared with the conventional method #1 as two catheter insertions, two catheter removals, and one engagement to the coronary artery, two steps compared with conventional method #2, or three steps compared with conventional method #3

Figure 2

Door‐to‐balloon time (D2B). The D2B time was significantly shorter in the single catheter primary percutaneous coronary intervention (SC‐PCI) method group (68 ± 46 vs. 76 ± 51 min, respectively; p = .02) than in the conventional method group. When the D2B time is divided into door‐to‐sheath (D2S) time and sheath‐to‐balloon (S2B) time, the S2B time was significantly different (19 ± 14 vs. 23 ± 14 min, respectively; p < .0001), but the D2S time was not significantly different (49 ± 42 vs. 53 ± 46 min, respectively; p = .18) [Color figure can be viewed at wileyonlinelibrary.com]

Figure 3

Radiation exposure dose and fluorescent time. (A) Radiation exposure dose and (B) fluorescent time [Color figure can be viewed at wileyonlinelibrary.com]

Figure 4

Analysis of sheath‐to‐balloon time by institute. Reduced sheath‐to‐balloon time with the single catheter primary percutaneous coronary intervention (SC‐PCI) method was analyzed separately for each institution. For this analysis, we used data from ten institutes, where at least five cases of the SC‐PCI method were enrolled. The sheath‐to‐balloon time in the SC‐PCI method was shorter in 90% of institutes, and the difference was statistically significant in 80%