Primary Percutaneous Coronary Intervention in a 24-hour PCI Capable Hospital in Indonesia
Article Sidebar
Main Article Content
Sidhi Laksono
Cliffian Hosanna
Irwan Surya Angkasa
Putri Nurbaeti
Abstract
Introduction: Chest pain may be a symptom of a life-threatening disease such as S ST-Elevation Myocardial Infarction (STEMI). Immediate primary percutaneous coronary intervention (PPCI) is recommended for virtually all STEMI patients who present in a PCI-capable hospital.
Objective: We would like to present data on Door-to-Balloon (DTB) times and the factors affecting it.
Methods: This is a single-center retrospective study. Patients are STEMI patients, undergoing primary PCI from 1st January 2024 to 30th April 2024. Secondary data are obtained from the medical records and analyzed.
Results: A total of 60 patients undergo PPCI during the study period. Patients are generally male patients, aged 53.67 years old, with 2 traditional cardiovascular risk factors, presenting to the emergency department (ED) with an average of 5.88 hours of chest pain. DTB time was 86.25 minutes during the study period. We identified the onset of chest pain and referred patients to be associated with DTB time. Referred patients had longer onset since chest pain but faster DTB time. We found no association between age, gender, presenting time, diagnosis, Killip class, and physician factor to significantly affect DTB time.
Conclusions: We have identified factors that may help us improve our DTB time. Patient knowledge should also be improved to increase awareness of symptoms of chest pain, minimizing patient delay and improving total ischemic time.
Downloads
Article Details
Copyright (c) 2025 Sidhi Laksono, Cliffian Hosanna, Irwan Surya Angkasa, Putri Nurbaeti
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
References
Alrawashdeh, A., Nehme, Z., Williams, B., Smith, K., Brennan, A., Dinh, D. T., Liew, D., Lefkovits, J., & Stub, D. (2021). Impact of emergency medical service delays on time to reperfusion and mortality in STEMI. Open Heart, 8(1), e001654. https://doi.org/10.1136/openhrt-2021-001654 DOI: https://doi.org/10.1136/openhrt-2021-001654
Amoras, T. S. G., Rodrigues, T. B., Menezes, C. R., Zaninotto, C. V., & Tavares, R. dos S. (2020). Door-to-balloon Time in Cardiovascular Emergency Care in a Hospital of Northern Brazil. International Journal of Cardiovascular Sciences. https://doi.org/10.36660/ijcs.20190104 DOI: https://doi.org/10.36660/ijcs.20190104
Byrne, R. A., Rossello, X., Coughlan, J. J., Barbato, E., Berry, C., Chieffo, A., Claeys, M. J., Dan, G. A., Dweck, M. R., Galbraith, M., Gilard, M., Hinterbuchner, L., Jankowska, E. A., Jüni, P., Kimura, T., Kunadian, V., Leosdottir, M., Lorusso, R., Pedretti, R. F. E., … Ibanez, B. (2023). 2023 ESC Guidelines for the management of acute coronary syndromes. European Heart Journal, 44(38), 3720–3826. https://doi.org/10.1093/eurheartj/ehad191 DOI: https://doi.org/10.1093/eurheartj/ehad191
Dharma, S. (2020). Comparison of Real-Life Systems of Care for ST-Segment Elevation Myocardial Infarction. Global Heart, 15(1). https://doi.org/10.5334/gh.343 DOI: https://doi.org/10.5334/gh.343
Emami, M., Mirzamohamadi, S., Heidari, A., Aein, A., Salarifar, M., & Nematipour, E. (2023). Evaluation of the Causes of Door-to-Balloon Time Delays in Patients with ST-Elevation Myocardial Infarction at Tehran Heart Center. The Journal of Tehran University Heart Center. https://doi.org/10.18502/jthc.v18i1.12584 DOI: https://doi.org/10.18502/jthc.v18i1.12584
Fabris, E., Arrigoni, P., Falco, L., Barbati, G., Stolfo, D., Peratoner, A., Vitrella, G., Rakar, S., Perkan, A., & Sinagra, G. (2020). Impact of patient delay in a modern real world STEMI network. The American Journal of Emergency Medicine, 38(6), 1195–1198. https://doi.org/10.1016/j.ajem.2020.02.028 DOI: https://doi.org/10.1016/j.ajem.2020.02.028
Hsiao, Y.-T., Hung, J.-F., Zhang, S.-Q., Yeh, Y.-N., & Tsai, M.-J. (2023). The Impact of Emergency Department Arrival Time on Door-to-Balloon Time in Patients with ST-Segment Elevation Myocardial Infarction Receiving Primary Percutaneous Coronary Intervention. Journal of Clinical Medicine, 12(6), 2392. https://doi.org/10.3390/jcm12062392 DOI: https://doi.org/10.3390/jcm12062392
Ibanez, B., James, S., Agewall, S., Antunes, M. J., Bucciarelli-Ducci, C., Bueno, H., Caforio, A. L. P., Crea, F., Goudevenos, J. A., Halvorsen, S., Hindricks, G., Kastrati, A., Lenzen, M. J., Prescott, E., Roffi, M., Valgimigli, M., Varenhorst, C., Vranckx, P., Widimský, P., … Gale, C. P. (2018). 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. European Heart Journal, 39(2), 119–177. https://doi.org/10.1093/eurheartj/ehx393 DOI: https://doi.org/10.5603/KP.2018.0041
Karam, N., Bataille, S., Marijon, E., Tafflet, M., Benamer, H., Caussin, C., Garot, P., Juliard, J.-M., Pires, V., Boche, T., Dupas, F., Le Bail, G., Lamhaut, L., Simon, B., Allonneau, A., Mapouata, M., Loyeau, A., Empana, J.-P., Lapostolle, F., … Lambert, Y. (2019). Incidence, Mortality, and Outcome-Predictors of Sudden Cardiac Arrest Complicating Myocardial Infarction Prior to Hospital Admission. Circulation: Cardiovascular Interventions, 12(1). https://doi.org/10.1161/CIRCINTERVENTIONS.118.007081 DOI: https://doi.org/10.1161/CIRCINTERVENTIONS.118.007081
Krumholz, H. M., Herrin, J., Miller, L. E., Drye, E. E., Ling, S. M., Han, L. F., Rapp, M. T., Bradley, E. H., Nallamothu, B. K., Nsa, W., Bratzler, D. W., & Curtis, J. P. (2011). Improvements in Door-to-Balloon Time in the United States, 2005 to 2010. Circulation, 124(9), 1038–1045. https://doi.org/10.1161/CIRCULATIONAHA.111.044107 DOI: https://doi.org/10.1161/CIRCULATIONAHA.111.044107
Li, L., Wu, M.-Y., Zhang, F., Li, S.-F., Cui, Y.-X., Hu, D., & Chen, H. (2018). Perspective of delay in door-to-balloon time among Asian population. Journal of Geriatric Cardiology : JGC, 15(12), 732–737. https://doi.org/10.11909/j.issn.1671-5411.2018.12.001
Liu, Z., Lim, M. J., Pek, P. P., Wong, A. S. L., Tan, K. B. K., Yeo, K. K., & Ong, M. E. H. (2021). Improved door-to-balloon time for primary percutaneous coronary intervention for patients conveyed via emergency ambulance service. Annals of the Academy of Medicine, Singapore, 50(9), 671–678. https://doi.org/10.47102/annals-acadmedsg.2021153 DOI: https://doi.org/10.47102/annals-acadmedsg.2021153
Martí, D., Mestre, J. L., Salido, L., Esteban, M. J., Casas, E., Pey, J., Sanmartín, M., Hernández-Antolín, R., & Zamorano, J. L. (2014). Incidence, angiographic features and outcomes of patients presenting with subtle ST-elevation myocardial infarction. American Heart Journal, 168(6), 884–890. https://doi.org/10.1016/j.ahj.2014.08.009 DOI: https://doi.org/10.1016/j.ahj.2014.08.009
Neumann, F. J., Sousa-Uva, M., Ahlsson, A., Alfonso, F., Banning, A. P., Benedetto, U., Byrne, R. A., Collet, J. P., Falk, V., Head, S. J., Jüni, P., Kastrati, A., Koller, A., Kristensen, S. D., Niebauer, J., Richter, D. J., Seferovic, P. M., Sibbing, D., Stefanini, G. G., … Roffi, M. (2019). 2018 ESC/EACTS Guidelines on myocardial revascularization. European Heart Journal, 40(2), 87–165. https://doi.org/10.1093/eurheartj/ehy394 DOI: https://doi.org/10.4244/EIJY19M01_01
Park, J. H., Ahn, K. O., Shin, S. Do, Cha, W. C., Ryoo, H. W., Ro, Y. S., & Kim, T. (2016). The first-door-to-balloon time delay in STEMI patients undergoing interhospital transfer. The American Journal of Emergency Medicine, 34(5), 767–771. https://doi.org/10.1016/j.ajem.2015.12.058 DOI: https://doi.org/10.1016/j.ajem.2015.12.058
Park, Y. H., Kang, G. H., Song, B. G., Chun, W. J., Lee, J. H., Hwang, S. Y., Oh, J. H., Park, K., & Kim, Y. D. (2012). Factors Related to Prehospital Time Delay in Acute ST-Segment Elevation Myocardial Infarction. Journal of Korean Medical Science, 27(8), 864. https://doi.org/10.3346/jkms.2012.27.8.864 DOI: https://doi.org/10.3346/jkms.2012.27.8.864
Prakash, B., Mohanta, R. R., Lal, P. P., & Shah, M. M. (2022). Reducing the Wire Crossing Time in Primary Percutaneous Coronary Angioplasty: A Study From a Tier II City in India. Cureus. https://doi.org/10.7759/cureus.21539 DOI: https://doi.org/10.7759/cureus.21539
Rizki Fadlan, M., Anjarwani, S., & Saifur Rohman, M. (2022). The role of STEMI integrated networking system based on tele-cardiology for reducing ischemic time and crossing wire time delayed during COVID 19 pandemic. European Heart Journal, 43(Supplement_1). https://doi.org/10.1093/eurheartj/ehab849.175 DOI: https://doi.org/10.1093/eurheartj/ehab849.175
Shah, J. A., Naz, F., Kumar, R., Hassan, M., Shah, G., Ahmed, K., Hussain, J., Abid, K., & Karim, M. (2021). Incidence of Cardiac Arrhythmias in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention and Associated Outcomes During the First 24 Hours. Cureus. https://doi.org/10.7759/cureus.12599 DOI: https://doi.org/10.7759/cureus.12599
Toledano, B. R. F., Garganera, K. B., Prado, J. P. A., Sabas, M. L., & Martinez, G. S. (2023). System Delays and Target Points: An Analysis of the ST-elevation MI Response Programme in a Single Centre. Journal of Asian Pacific Society of Cardiology, 2. https://doi.org/10.15420/japsc.2022.51 DOI: https://doi.org/10.15420/japsc.2022.51