Comparison of Quality Parameters, Among Different Coronary Beds, in Patients with ST Segment Myocardial Infarction Undergoing Primary Coronary Intervention

Background:
In STEMI, current guidelines advocate rapid performance of primary PCI with resulting reduced morbidity and mortality. However, quality measures, assessing prompt performance of primary PCI in association to culprit artery are scarce. We aimed to evaluate the association between the culprit coronary artery and quality measures of door to balloon (DTB) time and total ischemic time (TIT).

Methods:
Data was collected from Emek medical center primary PCI registry. Patients suffering from STEMI and undergoing primary PCI were classified according to the culprit artery (LAD, RCA and LCX). DTB, the proportion of patients with DTB less than 90 minutes and TIT were detailed.

Results:
Between 2010 and 2014 a total of 928 patients with STEMI underwent primary PCI. 138 were excluded from analysis because of biasing conditions (figure 1).No significant differences were noted in the average or median DTB between the groups. Nor was there a difference in the proportion of patients within each group with DTB less than 90 minutes. However, patients suffering from LCX related STEMI had significantly longer TIT compared to both LAD related STEMI (3.1 vs 2.7 hours, p<0.01) and RCA related STEMI (3.1 vs 2.5 hours, p<0.01).

Conclusion:
LCX related STEMI is associated with longer TIT and, in appropriate cases, necessitates additional investigational tools in order to minimize pre-hospital diagnosis delay.