Balloon Time Research Articles

Influence of social factors on prompt reperfusion in patients with ST-segment elevation myocardial infarction: results from the KRAMI multicenter registry

Abstract Background The time from symptom onset to reperfusion therapy was particularly important for ST-segment elevation myocardial infarction (STEMI) patients. We sought to investigate the impact of social factors on prompt reperfusion in STEMI patients. Methods A total of 5,264 patients with a diagnosis of STEMI from Korean Registry of Acute Myocardial Infarction (KRAMI) was participated in present study. The association between social factors and process of symptom onset-to-timely reperfusion was evaluated. Process of symptom-to-reperfusion time was included door-to-balloon (DTB) time, symptom-to-door (STD) time and symptom-to-balloon (STB) time. Results In the entire study population, the median times of DTB, STD and STB were 55 min, 117 min and 175 min, respectively. With 3 parameters, only DTB was associated with in-hospital mortality (Fig. 1 and 2). Old age and male were more likely to delay treatment (p for age=0.000; p for gender <0.0001). Moreover, higher education was linked to reduction of STD and STB time (p<0.05). Living alone was associated with prolonged STB time, and symptom appearing outside was linked to delay medical care. Transportation with ambulance was significantly associated with reduction of reperfusion time, and inter-hospital transportation was particularly prominent (STD: OR 5.450, 95% CI 4.796 - 6.193, p<0.0001; STB: OR 4.593, 95% CI 4.038 - 5.225, p<0.0001). In addition, treatment time during off-hours was relatively delayed DTB time. Conclusions Door to balloon time is directy related to in-hospital mortality. Social factors, such as age, gender, and education level, and transportation with ambulance were related to timely reperfusion in STEMI patients.

The cardiac sympathetic co-transmitter neuropeptide-Y is pro-arrhythmic in human cardiomyocytes by lengthening activation-recovery interval

Abstract Background Myocardial infarction (MI) is associated with sympathetic overactivity, during which the co-release of neuropeptide-Y (NPY) is prominent. NPY is associated with arrhythmia risk and mortality following ST-elevation MI, although the exact mechanisms for this in human cardiomyocytes remains unclear. Purpose We therefore tested the hypothesis that NPY signalling would alter the electrophysiology of human induced-pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) in a way that would promote arrhythmia, and that in patients being treated for MI, high NPY concentrations previously associated with ventricular arrhythmia (>27.3 pg.mL-1) would be associated with comparable ECG changes. Methods Immunohistochemistry and western blot were performed on hiPSC-CMs and ventricular biopsies from human patients undergoing valve surgery. The FRET-based sensor Epac-SH187 was expressed in hiPSC-CMs to monitor the cyclic adenosine 3’,5’-monophosphate (cAMP) response to NPY. A micro-electrode array was used to investigate the effects of NPY on a confluent layer of iPSC-CMs, measuring changes in activation, recovery, conduction velocity and spontaneous automaticity. Additionally, patients presenting with ST-elevation MI had peripheral venous [NPY] measured and compared to 12-lead ECGs recorded following stenting. Results hiPSC-CMs expressed Y1 and Y5 receptor mRNA and protein, which are also expressed in ventricular biopsies from human patients. NPY (1-100 nM) significantly reduced intracellular cAMP levels (n=65), most effectively prevented by Y5 receptor inhibition (1µM CGP71683A, n=40). In a confluent layer of hiPSC-CM, NPY (100 nM) slowed late-repolarisation represented by T-wave peak-end duration (p=0.04), which could be prevented by Y1-receptor inhibition (1 μM BIBO 3304, n=6), and caused prolongation of rate corrected activation-recovery interval (ARIc) (p=0.009, n=6) which could be abolished by Y5-receptor inhibition (n=7). NPY significantly increased automaticity to more than one site of initiation in 4/6 (66.7%) compared to 2/14 (14.3%) control plates (p=0.037), despite no change in conduction velocity. Moreover, in 65 patients being treated for ST elevation MI, those with high peripheral venous NPY concentrations were well matched in terms of cardiovascular risk factors, medications on admission, and pain to balloon times, but had significantly longer corrected QT interval (QTc) on the 12 lead ECG (p=0.04) despite no differences in PR interval, heart rate or electrolyte concentrations. Conclusions NPY slowed late repolarisation and caused ARIc prolongation, which was associated with increased automaticity in human iPSC-CMs. NPY also correlated with QTc-prolongation in patients being treated for MI and may contribute to the increased incidence of ventricular arrhythmia observed in these patients. Antagonists of Y1 and Y5 receptors may therefore offer an adjunct to β-blockade therapy to reduce the risk of ventricular arrhythmia.

433 Continuous Quality Improvement for Prehospital STEMI Results in Shorter Door to Balloon Times and Optimized Triage Rates

433 Continuous Quality Improvement for Prehospital STEMI Results in Shorter Door to Balloon Times and Optimized Triage Rates

The Influence of STEMI Activation Time on First-Medical-Contact to Balloon Time: A Prospective Single Centre Study

The Influence of STEMI Activation Time on First-Medical-Contact to Balloon Time: A Prospective Single Centre Study

Myocardial strain combined with clinical risk factors in the prediction of in-hospital heart failure among patients with ST-segment elevation myocardial infarction

To investigate the predictive value of myocardial strain derived from cardiac magnetic resonance (CMR) combined with clinical indicators for in-hospital heart failure (HF) in STEMI patients. In all, 139 STEMI patients were included, with 28 in the heart failure group and 111 in the non-HF group, and clinical and laboratory data were collected. Left ventricular (LV) global radial strain (GRS), global longitudinal strain (GLS), global circumferential strain (GCS), left ventricular ejection fraction (LVEF), stroke volume (SV), and infarct size (IS) were assessed by CMR. The HF group had worse GRS, GLS, GCS, LVEF, SV, larger IS, longer symptom to balloon time (SBT) and higher levels of high-sensitivity C-reactive protein (hs-CRP) and neutrophil percentage (N%) than the non-HF group (P<0.05). There was a strong correlation between GRS and LVEF (r=0.741, P<0.001). After adjustment for CMR and clinical risk factors, GRS<15.6%, LVEF<37.7%, SBT>350 min, hs-CRP>11.45 mg/L, and N%>74% were independently associated with HF. Clinical model (SBT>350 min+hs-CRP>11.45 mg/L+N%>74%) were associated with a lower diagnostic accuracy for predicting in-hospital HF than GRS+clinical co-model and LVEF+clinical co-model (P<0.05), respectively. There was no significant difference in the area under the curve (AUC) between GRS+clinical co-model and LVEF+clinical co-model (P=0.620): AUC for clinical model=0.824, AUC for GRS+clinical co-model=0.895, and AUC for LVEF+clinical co-model=0.907. GRS may be effective in predicting in-hospital heart failure after STEMI compared to LVEF, a classical cardiac function parameter, and its combination with clinical risk factors, especially SBT, hs-CRP, and N%, may provide further evidence for early prognostic assessment.

Reducing Door-to-Balloon Time Using EMS-Initiated App-Based Communication

BackgroundReducing door-to-balloon (D2B) time for ST-segment elevation myocardial infarction (STEMI) has been shown to improve outcomes. Delays still occur due to various factors such as time to laboratory activation and diagnostic clarification in equivocal cases. We propose that early communication through a mobile application (app) between emergency medical services (EMS) and in-hospital providers can reduce EMS-to-balloon time and provide coordinated care to impact D2B time. MethodsThe General Devices e-Bridge mobile app, which allows real-time communication and data transmission between EMS providers and the cardiac catheterization laboratory and emergency department staff, was implemented on May 14, 2019. A single-center, retrospective observational study was conducted on 795 STEMI activations undergoing emergent coronary angiography between January 2017 and July 2020. After exclusions, EMS transmissions of 428 cases were analyzed, of which 132 used the app. ResultsImplementation of e-Bridge significantly reduced D2B time by 7.2 minutes (P = .005) and emergency department board time by 4.41 minutes (P = .01). First medical contact to balloon (FMC2B) time trended toward reduction but was not statistically significant. The app did not significantly reduce D2B or FMC2B time during the day shift but significantly improved these metrics during the night shift. ConclusionsImplementation of app-based communication between EMS and in-hospital providers resulted in statistically significant reductions in D2B time at our institution. This approach holds promise in improving the timely management of STEMI patients, particularly during the night shift.

Clinical characteristics and outcomes of Australian and Indian ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI)

IntroductionThe incidence of STEMI and subsequent mortality has been reported to be higher in Indian populations compared to developed countries. However, there is limited data directly comparing contemporary primary percutaneous coronary intervention (pPCI) treatment strategies and clinical outcomes for STEMI patients between developed and developing countries. Materials and methodsWe compared population demographics, procedural characteristics, times to reperfusion and mortality in STEMI patients treated with pPCI between two tertiary referral centers in India and Australia respectively over a 3-year period (1st Jan 2017–31st Dec 2019). ResultsA total of 1293 STEMI presentations (896 Indian vs 397 Australian) were included. On average, Indian patients had lower median BMI than Australian patients (BMI 25.4 vs 27.8; p < 0.001), were significantly younger (mean age 56.0 vs 63.2 years; p < 0.001), more likely male (84 % vs 80 %; p = 0.046) and diabetic (48 % vs 18 %); p < 0.001). Radial access (50 % vs 88 %; p < 0.001) and TIMI III flow post PCI was also significantly lower (85 % vs 96 %; p < 0.001) with median door-to-balloon time significantly shorter in the Indian cohort (20mins vs 43mins; p < 0.001); however, median symptom to balloon time was significantly longer (245mins vs 160mins; p < 0.001). No significant differences in 30-day mortality (4.0 % vs 2.8 % Australian; p = 0.209) or 1-year mortality (6.5 % vs 4.3 %; p = 0.120) were observed. ConclusionSignificant differences in demographics and presentation characteristics exist between Indian and Australian STEMI patients treated with pPCI. Indian patients had significantly longer pre-hospital delays and lower achievement of TIMI III flow post PCI, yet shorter in-hospital time to treatment.

Restoring microvascular circulation with diagnostic ultrasound and contrast agent: rationale and design of the REDUCE trial

ObjectivesThis study aims to evaluate the efficacy and cost-effectiveness of sonothrombolysis delivered pre and post primary percutaneous coronary intervention (pPCI) on infarct size assessed by cardiac MRI, in patients presenting with STEMI, when compared against sham procedure. BackgroundMore than a half of patients with successful pPCI have significant microvascular obstruction and residual infarction. Sonothrombolysis is a therapeutic use of ultrasound with contrast enhancement that may improve microcirculation and infarct size. The benefits and real time physiological effects of sonothrombolysis in a multicentre setting are unclear. MethodsThe REDUCE (Restoring microvascular circulation with diagnostic ultrasound and contrast agent) trial is a prospective, multicentre, patient and outcome blinded, sham-controlled trial. Patients presenting with STEMI will be randomized to one of 2 treatment arms, to receive either sonothrombolysis treatment or sham echocardiography before and after pPCI. This tailored design is based on preliminary pilot data from our centre, showing that sonothrombolysis can be safely delivered, without prolonging door to balloon time. Our primary endpoint will be infarct size assessed on day 4±2 on Cardiac Magnetic Resonance (CMR). Patients will be followed up for 6 months post pPCI to assess secondary endpoints. Sample size calculations indicate we will need 150 patients recruited in total. ConclusionsThis multicentre trial will test whether sonothrombolysis delivered pre and post primary PCI can improve patient outcomes and is cost-effective, when compared with sham ultrasound delivered with primary PCI. The results from this trial may provide evidence for the utilization of sonothrombolysis as an adjunct therapy to pPCI to improve cardiovascular outcomes in STEMI. ANZ Clinical Trial Registration number: ACTRN 12620000807954

Implementation of a Novel Prehospital Clinical Decision Tool and ECG Transmission for STEMI Significantly Reduces Door-to-Balloon Time and Sex-Based Disparities

Background An important method employed to reduce door to balloon time (DTBT) for ST segment elevation Myocardial Infarctions (STEMIs) is a prehospital MI alert. The purpose of this retrospective study was to examine the effects of an educational intervention using a novel decision support method of STEMI notification and prehospital electrocardiogram (ECG) transmission on DTBT. Methods An ongoing database (April 4, 2000 – present) is maintained to track STEMI alerts. In 2007, an MI alert program began; emergency medicine physicians could activate a “prehospital MI alert”. In October 2015, modems were purchased for Emergency Medical Services personnel to transmit ECGs. There was concurrent implementation of a decision support tool for identifying STEMI. Sex was assigned as indicated in the medical record. Data were analyzed in two groups: Pre-2016 (PRE) and 2016–2022 (POST). Results In total, 3,153 patients (1,301 PRE; 1,852 POST) were assessed; the average age was 65.2 years, 32.6% female, 87.7% white with significant differences in age and race between the two cohorts. Of the total 3,153 MI alerts, 239 were false activations, leaving 2,914 for analysis. 2,115 (72.6%) had cardiac catheterization while 16 (6.7%) of the 239 had a cardiac catheterization. There was an overall decrease in DTBT of 27.5% PRE to POST of prehospital ECG transmission (p < 0.001); PRE median time was 74.5 min vs. 55 min POST. There was no significant difference between rates of cardiac catheterization PRE and POST for all patients. After accounting for age, race, and mode of arrival, DTBT was 12.2% longer in women, as compared to men (p < 0.001) PRE vs. POST. DTBT among women was significantly shorter when comparing PRE to POST periods (median 77 min vs. 60 min; p = 0.0001). There was no significant sex difference in the proportion of those with cardiac catheterization between the two cohorts (62.5% vs. 63.5%; p = 0.73). Conclusion Introduction of a decision support tool with prehospital ECG transmission with prehospital ECG transmission decreased overall DTBT by 20 min (27.5%). Women in the study had a 17-minute decrease in DTBT (22%), but their DTBT remained 12.2% longer than men for reasons that remain unclear.

SYNERGY—Everolimus-Eluting Stent With a Bioabsorbable Polymer in ST-Elevation Myocardial Infarction: CLEAR SYNERGY OASIS-9 Registry

Our objective was to evaluate the clinical effectiveness of the SYNERGY stent in patients with ST elevation myocardial infarction (STEMI). The only drug eluting stent approved for treatment of STEMI by the FDA is the Taxus stent which is no longer commercially available, so further data are needed. The CLEAR SYNERGY stent registry was embedded into a larger randomized trial of patients with STEMI (N=7000), comparing colchicine vs. placebo and spironolactone vs. placebo. The primary outcome for the SYNERGY stent registry is major adverse cardiac events (MACE) as defined by cardiovascular death, recurrent MI, or unplanned ischemia driven target vessel revascularization (TVR) within 12 months. We estimated a MACE rate of 6.3% at 12 months after primary percutaneous coronary intervention (PPCI) for STEMI based on the TOTAL trial. Success was defined as upper bound of confidence interval (CI) to be less than the performance goal of 9.45%.Overall, 733 patients were enrolled from 8 countries with a mean age 60.2 years, 19% diabetes, 41.3% anterior MI and median door to balloon time of 72 minutes. The MACE rate was 4.8% (95% CI 3.2-6.3%) at 12 months which met the success criteria against performance goal of 9.45%. The rates of cardiovascular death, recurrent MI or TVR were 2.7%, 1.9%, 1.0% respectively. The rates of acute definite stent thrombosis were 0.3%, subacute 0.4%, late 0.4% and cumulative stent thrombosis of 1.1% at 12 months. In conclusion, the SYNERGY stent in STEMI performed well and was successful compared to the performance goal based on prior trials.Trial Registration: ClinicalTrials.gov Identifier: NCT03048825

Applying Tension to the Transcervical Foley Balloon and Delivery Times in Term Nulliparous Women Undergoing Induction of Labor: A Randomized Controlled Trial.

To investigate the effects of applying tension to a transcervical Foley balloon on delivery time in term nulliparous patients undergoing labor induction. This cluster randomized clinical trial included 279 term nulliparous women presenting for labor induction with a plan for cervical ripening through transcervical Foley balloon placement. Participants were assigned to either the tension group (n=138) or the no-tension group (n=141) on the basis of randomized, weekly clusters (26 total clusters). The primary outcome measured was the time from initial Foley balloon insertion to delivery. Secondary outcomes included cesarean delivery rates, peripartum infection, and neonatal intensive care unit (NICU) admission. Our prior data suggested that delivery time in the tension group would be about 1,053 minutes. We estimated a sample size of 260 (130 per group, 26 clusters) on the basis of a 25% difference, power of 80%, and two-sided α of 0.05. A total of 279 term nulliparous patients were included in the analysis. The median time from Foley placement to delivery was 1,596 minutes (range 430-3,438 minutes) for the tension group and 1,621 minutes (range 488-3,323 minutes) for the no-tension group ( P =.8); similar results were noted for time to vaginal delivery. No significant differences were observed in the secondary outcomes, including the rates of cesarean delivery (34.1% vs 29.8%, P =.7), peripartum infection, and NICU admission, between the two groups. Applying tension to a transcervical Foley balloon in term nulliparous women undergoing labor induction did not significantly reduce delivery time or improve secondary outcomes. ClinicalTrials.gov , NCT05404776.

Optimizing Door-to-Balloon Time for Patients Undergoing Primary Percutaneous Coronary Intervention at King Abdullah Medical City.

The acute myocardial infarction mortality risk rises by 8% per year for every 30-minute delay in early coronary intervention following the onset of symptoms. Thus, it is important to reduce the door-to-balloon time as much as possible, especially in hospitals where early coronary intervention is carried out within 90 minutes. The purpose of this study was to determine the impact of King Abdullah Medical City's strategies on balloon time for patients with ST elevation myocardial infraction. Prospective observational research was conducted in King Abdullah Medical City. This study included 67 patients who had a primary percutaneous coronary intervention. Data were collected in Hajj 2023 through direct observation using a checklist that included two parts: (I) patients' demographic characteristics and relevant time intervals. The data were analyzed using descriptive statistics (frequency and percentage; median and interquartile range) and inferential statistics (Mann-Whitney U test, Kruskal-Wallis H test, Spearman correlation coefficient test). It was noted that the median overall door-to-balloon time was 68 minutes for direct admission patients and 100 minutes (median) for interhospital transferred patients, with a statistically significant P value of 0.001. DTBT had no significant correlation with either the length of stay or hospital mortality rates (P > 0.05). King Abdullah Medical City accomplished an international benchmark in door-to-balloon time for ST elevation myocardial infraction patients visiting the hospital for percutaneous coronary intervention during the hajj season. Healthcare organizations can take proactive steps to optimize the management of STEMI cases. This includes establishing efficient communication channels, standardizing protocols, and facilitating seamless transitions between healthcare facilities.

Sonothrombolysis with microbolus administration of perfluoropropane as point of care therapy for STEMI patients

Abstract Introduction There are still major obstacles to timely revascularisation of STEMI patients even on arrival to PCI capable centers. Delivery of intermittent high mechanical index(MI) pulses during contrast infusion(Sonothrombolysis) has been shown to improve culprit vessel recanalization rates, reduce infarct size and improve myocardial hemodynamics. Purpose Our objective was to see if sonothrombolysis administered with a low dose of echo contrast(2mL) given as successive microboluses resulted in angiographic recanalisation. This is pertinent in our resource limited setup as continuous infusion needs specialised pumps and cost of echo contrast is high. Methods This was a randomised control trial on 100 patients presenting with first STEMI (within a window period of 12 hours, Killips stage I or II) to the Chest Pain Unit(CPU) of our institution. The intervention was sonothrombolysis during successive microboluses of perfluoropropane followed by PPCI. Technique of Sonothombolysis: 1 vial of perfluoropropane(2mL) is agitated and diluted in 20ML normal saline(0.1%w/v). Using a 3 way stop cock, 2mL solution is given while performing echocardiography in standard views. This leads to good chamber opacification for 40-60 beats. Once chamber opacification is adequately achieved (usually within 10 beats), high MI pulses (&amp;gt;1.1 MI) were given repeatedly after low MI imaging shows replenishment of microbubbles in the myocardial segment. Once opacification wanes, then another bolus of 2mL is given and steps repeated. The control group underwent low MI imaging with 0.2mL of perfluoropropane followed by PPCI. Results The trial was halted after recruitment of 57 patients following an interim analysis which showed no significant benefit with sonothrombolysis. Angiographic recanalization of culprit vessel occured in 28% of cases (8vs6, p=0.589). Baseline characteristics were similar across both groups. The time from first medical contact(FMC) to balloon time were similar. The use of Gp IIb/IIIa inhibitors or thrombus aspiration catheters did not differ. Discussion Sonothrombolysis with successive microboluses of perflouropropane is not effective in producing angiographic recanalization in STEMI patients. Our results vary from that of Mathias et al which showed a 48% angiographic recanalization rate. The protocol of giving microboluses as against continuous infusion could have contributed though we looked specifically for microbubble replenishment in myocardial segments before delivering high MI pulses. Secondly the higher prevalence of diabetes, dyslipidemia and multivessel CAD in our population could have contributed to the lack of efficacy. Thirdly the mean window period (time between onset of symptoms to arrival at CPU) was 7±2.31hrs which could have contributed to thrombus organization and resistance to shearing forces produced by microbubble cavitation. Further randomized studies are needed to see the efficacy of sonothrombolysis in other populations.Table 1.Baseline CharacteristicsTable 2.Results

Factors for delays in door-to-balloon time ≤ 90 min in an electrocardiogram triage system among patients with ST-segment elevation myocardial infarction: a retrospective study

BackgroundDoor to balloon time is a crucial factor of mortality in patients with ST-segment elevation myocardial infarction. However, the factors that contribute to failure of achieving door to balloon time ≤ 90 min in an electrocardiogram triage system remain unknown.MethodsThis single-center retrospective observational study collected data from consecutive patients with ST-segment elevation myocardial infarction from April 2016 to March 2021. The primary outcome was the failure to achieve door to balloon time ≤ 90 min. A multivariate logistic regression model was performed to predict factors associated with failure to achieve door to balloon time ≤ 90 min.ResultsIn total, 190 eligible patients were included. Of these, the 139 (73.2%) patients with door to balloon time ≤ 90 min were significantly younger compared to those with door to balloon time > 90 min (p = 0.02). However, there was no significant difference in sex and timing of hospital arrival between the door to balloon time ≤ 90 and > 90 min groups. Presence of chest pain and ambulance usage were significantly more frequent in patients with door to balloon time ≤ 90 min (p ≤ 0.01, p = 0.02, respectively). Multivariate analysis showed that absence of chest pain (adjusted odds ratio 4.76; 95% confidence interval, 2.04–11.1; p < 0.01) and non-ambulance usage (adjusted odds ratio 3.53; 95% confidence interval, 1.57–7.94; p < 0.01) are predictive factors of failure to achieve door to balloon time ≤ 90 min.ConclusionPatients without chest pain as the chief complaint or non-ambulance usage were significantly associated with the failure to achieve door to balloon time ≤ 90 min.

Analysis of Intra-Aortic Balloon Performance in Open-Heart Surgery

A failing heart can be supported in several ways, including cardiopulmonary bypass pumps (CPB), extracorporeal membrane oxygenators (ECMOs), and other types of auxiliary heart pumps. The intra-aortic-balloon-pump (IABP) is one technique of internal counter-pulsation that supports maintaining the circulatory system It continues to be used as a vascular support device to critically unwell cardiac patients. Many recent studies have focused on the problems of the (IABP) in open-heart surgery, while other researchers concentrated on the positioning and size of the balloon, some of them studied the timing of the balloon's inflation and deflation. this paper has reviewed a brief Introduction, the basic principles of the balloon, how to trigger the balloon pump as well as the use of IABP in Coronary Artery Bypass Graft (CABG), balloon mistiming of inflation and deflation, balloon timing usage within open-heart surgery and finally a balloon position and sizing.

The Influence of Presentation Timing and Door to Balloon Timing on the Clinical Outcomes in Primary Percutaneous Coronary Intervention

For best clinical results, ST-segment elevation myocardial infarction (STEMI) must be treated quickly. This prospective observational study, conducted at Peshawar institute of cardiology (PIC), Pakistan, from November 23, 2022, to August 16, 2023, examines the connection between clinical outcomes in 120 primary Percutaneous Coronary Intervention (PCI) cases, presentation timing (the period of time from symptom onset to hospital arrival), and Door-to-Balloon (D2B) time. Objective: to pave the road for more efficient, patient-centered care by fostering a more thorough awareness of the complexities involved in the management of acute STEMI. Methods: Demographic data, presentation timing, D2B times, and clinical outcomes were collected. Correlation analysis and regression modeling were employed to investigate the impact of presentation timing on D2B time and clinical outcomes. Sub-group analyses were conducted based on age and gender. Results: The relevance of an early presentation was highlighted by the study's substantial negative association between presentation timing and D2B time (r = -0.62, p 0.001). Smaller myocardial infarct sizes and a decreased frequency of major adverse cardiac events (MACE) were seen in patients with D2B times under 90 minutes. Age and gender differences were seen in this connection, according to subgroup analysis. Conclusion: Timely patient presentation is crucial in achieving shorter D2B times, leading to improved clinical outcomes in primary PCI for STEMI. These findings underscore the need for public awareness campaigns and streamlined hospital protocols to optimize STEMI management.

Relationship between the Fibrinogen/Albumin Ratio and Microvascular Perfusion in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Elevated Myocardial Infarction: A Prospective Study.

Correct TIMI frame count (CTFC), myocardial blush grade (MBG), and ST-segment resolution (STR) are parameters used to evaluate reperfusion at the microvascular level in patients that have undergone primary percutaneous coronary intervention (pPCI). Fibrinogen-to-albumin ratio (FAR) has been associated with thrombotic events in patients with ST-elevation myocardial infarction (STEMI) and chronic venous insufficiency. To investigate the relationship of FAR with CTFC, MBG, and STR. Methods: The study included 167 consecutive patients who underwent successful pPCI for STEMI and achieved TIMI-3 flow. The cases were divided into two groups, high (>0.0765) and low FAR (≤0.0765), according to the cut-off value of this parameter in the receiver operator characteristic analysis (ROC). STR, CTFC, and MBG were used to evaluate myocardial reperfusion. P values<0.05 were considered statistically significant. CTFC value, SYNTAX score, neutrophil/lymphocyte ratio, low-density lipoprotein, glucose, and peak cTnT were significantly higher, whereas STR, MBG, and LVEF were lower in the high FAR group. Spearman's correlation analysis revealed a significant relationship between the FAR and STR (r=-0.666, p<0.001), MBG (-0.523, p<0.001), and CTFC (r=0.731, p≤0.001). According to the logistic regression analysis, FAR, glucose, peak cTnT, and pain to balloon time were the most important independent predictors of MBG 0/1, CTFC>28, and STR<50%).ROC analysis revealed that the cut-off value of FAR≥0.0765 was a predictor of incomplete STR with a sensitivity of 71.9 % and a specificity of 69.8 %, MBG0/1 with a sensitivity of 72.6 % and a specificity of 68.6 %, and CTFC >28 with a sensitivity of 76 % and a specificity of 65.8 %. FAR is an important independent predictor of microvascular perfusion in patients undergoing pPCI for STEMI.

Door to Balloon Time of Non-ST Elevation Myocardial Infarction May be Reconsidered According to Systemic Immune-Inflammation Index.

Aim Early diagnosis and treatment is very important in acute coronary syndromes (ACS). Previous studies showed that not all non-ST elevation myocardial infarction (NSTEMI) patients should be considered and treated in the same way. The systemic immune-inflammation index (SII), which is an easily accessible, rapidly computed, and cost-effective parameter, was evaluated in this study to determine the optimal intervention time for NSTEMI.Material and methods 469 patients diagnosed with ACS were included to the study. STEMI and NSTEMI patients were compared according to their SII. Univariate and binary logistic regression analysis were performed to determine which parameters have a significant effect on the discrimination of types of myocardial infarction.Results The mean age of the patients was 61.43±11.52 yrs, and 348 (74.2 %) were male. NSTEMI patients with an SII value higher than 768×109 / l may be assumed to be STEMI (p&lt;0.001). Univariate analysis and binary logistic regression showed that only SII and hypertension had statistically impact on differentiation of STEMI and NSTEMI. In addition, SII value of 1105×109 / l was the cut-off point for discrimination of cardiovascular survival (p&lt;0.001, AUC =0.741). This study was performed to find out which NSTEMI patients should be treated percutaneously immediately after first medical contact according to SII. It was found that, SII value of higher than 768×109 / l is related with STEMI.Conclusion In conclusion, NSTEMI patients with a SII value higher than 768×109 / l may be considered as STEMI and treated with in 120 min after first contact. In addition, SII was found to be a cardiovascular mortality predictor after myocardial infarction, and this may be used for identifying high-risk patients after percutaneous coronary intervention.

A-183 Improving Turnaround Time of Critical Value Reporting by Reducing Redundant Workflow

Abstract Background Most laboratories and hospital patient safety committee define the critical value parameter together, and laboratory should notice the doctor when critical value reporting. “Critical value” as a result refers to the patient may be life-threatening or in imminent danger and require immediate treatment by a doctor. Especially, Troponin-I result is greatly affect door to balloon time. As soon as the critical value reporting, the patient will get therapy earlier. For patient safety, we implemented some methods to reduce the turnaround time of critical value reporting. Methods (1) Shorten the distance between specimen receiver and testing operator from 2 meter to 0 meter. Specimens are analyzed sooner due to reduced unnecessary walk. (2) Assess the difference of results between first and second exam, there are no significant difference. Reducing unnecessary repeat test to report critical value as soon as possible. (3) Reading barcode by both clockwise and counterclockwise way to improve barcode reading performance of analyzer, and reducing unnecessary re-label or manual operate. Results Emergency patient critical value report in 30 min completion rate increased from 80.5% to 93.3%. Inpatient critical value report in 60 min completion rate increased from 94.1% to 96.6%. Troponin-I report in 30 min completion rate increased from 89.3% to 97.0%. Conclusion Doctors treat according to result from laboratory, and delayed report is an impediment to patient care. Particularly critical value reports, that causes delays in urgent patient treatment. We reduced unnecessary work to short turnaround time for critical value reporting, patient will get better therapy faster, and further improve patient safety.

Impact of Regional Network on the Management of STEMI Patients in North Cairo

Abstract Background Worldwide, coronary artery disease (CAD) is the single most frequent cause of death. Over seven million people every year die from CAD. The management of patients with STElevation myocardial infarction (STEMI) is influenced by health care service organizations. Regional STEMI networks for acute myocardial infarction facilitate primary percutaneous coronary intervention (PPCI) and its efficacy in reducing mortality and improving its outcomes. Aim of the Work The aim of the present study was to examine the impact of regional STEMI network on patients' management and on hospital outcomes in north Cairo governorate, Egypt. Methods The present study is a Prospective observational multicenter study that was conducted on 352 patients with STEMI and symptom onset within 48 hours who presented to north Cairo hospitals. The patients were divided into 2 groups, group I in the first six months before establishment of a network between the north Cairo hospitals and group II in the second six months when the network between those hospitals was activated. Comparison was done between the two groups as regards patients' demographics, logistics of presentation and in hospital outcomes. Results The number of patients upon implementation of STEMI network increased from 140 to 212 (51.4%) to the same hospitals with the same facilities and in equal periods of time (6 months). It was found that the mean time of chest pain to first medical contact (FMC) between the two groups before and after establishment of STEMI network did not change, it was 4 hours in both groups (P = 0.36) while the mean door to balloon time improved from 54.3 to 44.1 minutes (P = 0.01). In our study thrombolytic therapy use declined from 36.4% before STEMI network set up to only 7.5% (P &amp;gt; 0.001), Ejection fraction (EF) improved from 51.3% to 55.4% (P &amp;gt; 0.001), mitral regurge (MR) also improved upon establishment of STEMI network from 53.6% to 78.8 with (P &amp;gt; 0.001), the mean CCU stay in group II was 2 days versus 3 days before implementation of STEMI network (P &amp;gt; 0.001), the mean door in door out from the spokes was 40 minutes. In-hospital mortality improved upon establishment of STEMI network from 6.4% to 2.8% (P = 0.10). Conclusion The establishment of the STEMI network in Egypt is feasible and can lead to improvement of patients' outcomes. Thrombolytic therapy was no longer the main reperfusion therapy and primary PCI was offered to most patients after establishment of STEMI network.