Disparity of Performance Measure by Door-to-Balloon Time Between a Rural and Urban Area for Management of Patients With ST-Segment Elevation Myocardial Infarction　- Insights From the Nationwide Japan Acute Myocardial Infarction Registry

• Published in: Circulation journal : official journal of the Japanese Circulation Society 2023-04, Vol.87 (5), p.648-656, Article CJ-22-0454
• Main Authors: Fukui, Kento, Takahashi, Jun, Hao, Kiyotaka, Honda, Satoshi, Nishihira, Kensaku, Kojima, Sunao, Takegami, Misa, Sakata, Yasuhiko, Itoh, Tomonori, Watanabe, Tetsu, Takayama, Morimasa, Sumiyoshi, Tetsuya, Kimura, Kazuo, Yasuda, Satoshi
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Female; Hospital Mortality; Humans; Japan - epidemiology; Male; Middle Aged; Myocardial Infarction - diagnosis; Myocardial Infarction - therapy; Percutaneous Coronary Intervention; Registries; Retrospective Studies; ST Elevation Myocardial Infarction - diagnosis; ST Elevation Myocardial Infarction - therapy; Treatment Outcome
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-22-0454

Although a door-to-balloon (D2B) time ≤90 min is recognized as a key indicator of timely reperfusion for patients with ST-segment elevation myocardial infarction (STEMI), it is unclear whether regional disparities in the prognostic value of D2B remain in contemporary Japan. We retrospectively analyzed 17,167 STEMI patients (mean [±SD] age 68±13 years, 77.6% male) undergoing primary percutaneous coronary intervention. With reference to the Japanese median population density of 1,147 people/km , patients were divided into 2 groups: rural (n=6,908) and urban (n=10,259). Compared with the urban group, median D2B time was longer (70 vs. 62 min; P90 min. These data suggest that there is a substantial rural-urban gap in the prognostic significance of D2B time among STEMI patients, especially those with cardiogenic shock and a prolonged D2B time.