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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
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 analyz...
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| Published in: | Circulation journal : official journal of the Japanese Circulation Society 2023-04, Vol.87 (5), p.648-656, Article CJ-22-0454 |
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| cited_by | cdi_FETCH-LOGICAL-c431t-37ada5710d3f334908fe951bc3231850af52c489ca78192fcdfd3e2aeace5da23 |
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| cites | cdi_FETCH-LOGICAL-c431t-37ada5710d3f334908fe951bc3231850af52c489ca78192fcdfd3e2aeace5da23 |
| container_end_page | 656 |
| container_issue | 5 |
| container_start_page | 648 |
| container_title | Circulation journal : official journal of the Japanese Circulation Society |
| container_volume | 87 |
| creator | 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 |
| description | 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. |
| doi_str_mv | 10.1253/circj.CJ-22-0454 |
| format | article |
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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; P<0.001) and the rate of achieving a D2B time ≤90 min was lower (70.7% vs. 75.4%; P<0.001) in the rural group. In-hospital mortality was lower for patients with a D2B time ≤90 min than >90 min, regardless of residential area, whereas multivariable analysis identified prolonged D2B time as a predictor of in-hospital death only in the rural group (adjusted odds ratio 1.57; 95% confidence interval 1.18-2.09; P=0.002). Importantly, the rural-urban disparity in in-hospital mortality emerged most distinctively among patients with Killip Class IV and a D2B time >90 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.</description><identifier>ISSN: 1346-9843</identifier><identifier>ISSN: 1347-4820</identifier><identifier>EISSN: 1347-4820</identifier><identifier>DOI: 10.1253/circj.CJ-22-0454</identifier><identifier>PMID: 36464277</identifier><language>eng</language><publisher>Japan</publisher><subject>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</subject><ispartof>Circulation journal : official journal of the Japanese Circulation Society, 2023-04, Vol.87 (5), p.648-656, Article CJ-22-0454</ispartof><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c431t-37ada5710d3f334908fe951bc3231850af52c489ca78192fcdfd3e2aeace5da23</citedby><cites>FETCH-LOGICAL-c431t-37ada5710d3f334908fe951bc3231850af52c489ca78192fcdfd3e2aeace5da23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36464277$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fukui, Kento</creatorcontrib><creatorcontrib>Takahashi, Jun</creatorcontrib><creatorcontrib>Hao, Kiyotaka</creatorcontrib><creatorcontrib>Honda, Satoshi</creatorcontrib><creatorcontrib>Nishihira, Kensaku</creatorcontrib><creatorcontrib>Kojima, Sunao</creatorcontrib><creatorcontrib>Takegami, Misa</creatorcontrib><creatorcontrib>Sakata, Yasuhiko</creatorcontrib><creatorcontrib>Itoh, Tomonori</creatorcontrib><creatorcontrib>Watanabe, Tetsu</creatorcontrib><creatorcontrib>Takayama, Morimasa</creatorcontrib><creatorcontrib>Sumiyoshi, Tetsuya</creatorcontrib><creatorcontrib>Kimura, Kazuo</creatorcontrib><creatorcontrib>Yasuda, Satoshi</creatorcontrib><creatorcontrib>JAMIR Investigators</creatorcontrib><creatorcontrib>on behalf of the JAMIR Investigators</creatorcontrib><title>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</title><title>Circulation journal : official journal of the Japanese Circulation Society</title><addtitle>Circ J</addtitle><description>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; P<0.001) and the rate of achieving a D2B time ≤90 min was lower (70.7% vs. 75.4%; P<0.001) in the rural group. In-hospital mortality was lower for patients with a D2B time ≤90 min than >90 min, regardless of residential area, whereas multivariable analysis identified prolonged D2B time as a predictor of in-hospital death only in the rural group (adjusted odds ratio 1.57; 95% confidence interval 1.18-2.09; P=0.002). Importantly, the rural-urban disparity in in-hospital mortality emerged most distinctively among patients with Killip Class IV and a D2B time >90 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.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Female</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Japan - epidemiology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - diagnosis</subject><subject>Myocardial Infarction - therapy</subject><subject>Percutaneous Coronary Intervention</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>ST Elevation Myocardial Infarction - diagnosis</subject><subject>ST Elevation Myocardial Infarction - therapy</subject><subject>Treatment Outcome</subject><issn>1346-9843</issn><issn>1347-4820</issn><issn>1347-4820</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNptkT1v1EAQhi0EIiHQU6EpaTas9-Nsl8klgZxygJKLKK259fhuI9t72V0Tuct_pec34HMCFdW88_E-U7xJ8j7lx6nQ8pOx3twdzxdMCMaVVi-Sw1SqjKlc8JeTnrEiV_IgeRPCHeei4Lp4nRzImZopkWWHye8zG3bobRzA1fCdfO18i50hWBKG3hOsBzhzzrPo2Ck2jXMdrGxLcErxgagDhOveYwPYVXDr19jBiSeEkQNL7HBDLXVxgmO0owzww8Yt3KzYDW2m3XlDP8fdCF4OzqCv7Ii77Gr0Zj_99fjIxjbYzXY0X3jXQtwSfJ0sD7YiWOBu_9b0kf6PgGva2BD98DZ5VWMT6N1zPUpuL85X8y_s6tvny_nJFTNKppHJDCvUWcorWUupCp7XVOh0baSQaa451loYlRcGszwtRG2qupIkkNCQrlDIo-TjE3fn3X1PIZatDYaaBjtyfShFpjLOtRZqPOVPp8a7EDzV5c7bFv1Qprzcp1xOKZfzRSlEuU95tHx4pvfrlqp_hr-xyj-y9Kos</recordid><startdate>20230425</startdate><enddate>20230425</enddate><creator>Fukui, Kento</creator><creator>Takahashi, Jun</creator><creator>Hao, Kiyotaka</creator><creator>Honda, Satoshi</creator><creator>Nishihira, Kensaku</creator><creator>Kojima, Sunao</creator><creator>Takegami, Misa</creator><creator>Sakata, Yasuhiko</creator><creator>Itoh, Tomonori</creator><creator>Watanabe, Tetsu</creator><creator>Takayama, Morimasa</creator><creator>Sumiyoshi, Tetsuya</creator><creator>Kimura, Kazuo</creator><creator>Yasuda, Satoshi</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20230425</creationdate><title>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</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c431t-37ada5710d3f334908fe951bc3231850af52c489ca78192fcdfd3e2aeace5da23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Female</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Japan - epidemiology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - diagnosis</topic><topic>Myocardial Infarction - therapy</topic><topic>Percutaneous Coronary Intervention</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>ST Elevation Myocardial Infarction - diagnosis</topic><topic>ST Elevation Myocardial Infarction - therapy</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fukui, Kento</creatorcontrib><creatorcontrib>Takahashi, Jun</creatorcontrib><creatorcontrib>Hao, Kiyotaka</creatorcontrib><creatorcontrib>Honda, Satoshi</creatorcontrib><creatorcontrib>Nishihira, Kensaku</creatorcontrib><creatorcontrib>Kojima, Sunao</creatorcontrib><creatorcontrib>Takegami, Misa</creatorcontrib><creatorcontrib>Sakata, Yasuhiko</creatorcontrib><creatorcontrib>Itoh, Tomonori</creatorcontrib><creatorcontrib>Watanabe, Tetsu</creatorcontrib><creatorcontrib>Takayama, Morimasa</creatorcontrib><creatorcontrib>Sumiyoshi, Tetsuya</creatorcontrib><creatorcontrib>Kimura, Kazuo</creatorcontrib><creatorcontrib>Yasuda, Satoshi</creatorcontrib><creatorcontrib>JAMIR Investigators</creatorcontrib><creatorcontrib>on behalf of the JAMIR Investigators</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation journal : official journal of the Japanese Circulation Society</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fukui, Kento</au><au>Takahashi, Jun</au><au>Hao, Kiyotaka</au><au>Honda, Satoshi</au><au>Nishihira, Kensaku</au><au>Kojima, Sunao</au><au>Takegami, Misa</au><au>Sakata, Yasuhiko</au><au>Itoh, Tomonori</au><au>Watanabe, Tetsu</au><au>Takayama, Morimasa</au><au>Sumiyoshi, Tetsuya</au><au>Kimura, Kazuo</au><au>Yasuda, Satoshi</au><aucorp>JAMIR Investigators</aucorp><aucorp>on behalf of the JAMIR Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>Circulation journal : official journal of the Japanese Circulation Society</jtitle><addtitle>Circ J</addtitle><date>2023-04-25</date><risdate>2023</risdate><volume>87</volume><issue>5</issue><spage>648</spage><epage>656</epage><pages>648-656</pages><artnum>CJ-22-0454</artnum><issn>1346-9843</issn><issn>1347-4820</issn><eissn>1347-4820</eissn><abstract>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; P<0.001) and the rate of achieving a D2B time ≤90 min was lower (70.7% vs. 75.4%; P<0.001) in the rural group. In-hospital mortality was lower for patients with a D2B time ≤90 min than >90 min, regardless of residential area, whereas multivariable analysis identified prolonged D2B time as a predictor of in-hospital death only in the rural group (adjusted odds ratio 1.57; 95% confidence interval 1.18-2.09; P=0.002). Importantly, the rural-urban disparity in in-hospital mortality emerged most distinctively among patients with Killip Class IV and a D2B time >90 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.</abstract><cop>Japan</cop><pmid>36464277</pmid><doi>10.1253/circj.CJ-22-0454</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Circulation journal : official journal of the Japanese Circulation Society, 2023-04, Vol.87 (5), p.648-656, Article CJ-22-0454 |
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| language | eng |
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| source | Freely Accessible Journals |
| 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 |
| title | 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 |
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