Abstract 11722: Assessing Disparity of Performance Measure by Door-to-Balloon Time Between Rural and Urban Area for Management of Patients with ST-Segment Elevation Myocardial Infarction -Insights from the Nationwide Japan Acute Myocardial Infarction Registry-

Abstract

Background: Door to balloon time (D2B) ≤90 minutes is a key indicator of quality of care for ST-segment elevation myocardial infarction (STEMI). The development of standardized management for STEMI may narrow the performance gap between rural and urban hospitals. However, there are few studies to explore the disparity of D2B and outcomes between rural and urban areas. Methods and Results: The Japan Acute Myocardial Infarction Registry (JAMIR) is a nationwide, real-world registry study. We retrospectively analyzed 17,938 STEMI patients (68±13 years, female 22.4%) treated with percutaneous coronary intervention, who were divided into the following two groups according to population density of 1147 persons/km 2 ; patients hospitalized in rural area and those in urban area. Overall, the median D2B was 72 mins and 73% achieved the target D2B ≤90 mins. Patients with D2B ≤90 mins had a lower in-hospital mortality compared with those with D2B >90 mins (4.7% vs. 8,4%, P<0.001). Rural patients were characterized by higher age, more accumulation of coronary risk factors and a higher prevalence of Killip class ≥2 at presentation compared with urban patients. The median D2B was longer (70 mins vs. 62 mins, P<0.001) and achievement rate for D2B ≤90 mins was lower (70% vs. 75%, P<0.001) in rural group than urban group ( Figure A ). In-hospital mortality tended to be higher in rural group (6.1% vs. 5.5%, P=0.06), whereas the benefit in shortening of D2B was noted equally in both groups ( Figure B ). Conclusions: The real-world nationwide study of JAMIR demonstrated that shortening of D2B time was significantly associated with survival benefit of STEMI in both rural and urban area.