CT scan before angioplasty increases door-to-balloon time
MedWire News: Computed tomography (CT) scanning before a primary percutaneous coronary intervention (PCI) procedure is associated with significantly longer door-to-balloon times, researchers suggest.
"System delays in primary PCI are associated with increased mortality and an increased risk of heart failure during long-term follow-up," caution James McCabe (Harvard Medical School, Boston, Massachusetts, USA) and team in The American Journal of Cardiology.
They analyzed the ACTIVATE-SF registry, which consists of consecutive patients with a clinical diagnosis of ST-segment-elevation myocardial infarction (STEMI) who were admitted to the emergency departments of two urban hospitals between October 2008 and April 2011.
Of 410 patients with a suspected diagnosis of STEMI, 45 (11%) underwent CT scanning before PCI. Only two (4%) of these CT scans changed the course of clinical management by identifying a stroke.
Compared with patients who did not undergo CT scanning before PCI, those who did had significantly longer door-to-balloon times, at a median of 75 minutes versus 166 minutes, and higher in-hospital mortality, at 7.8% versus 20% (p<0.006 for both).
Multivariate analysis also showed that CT scanning before PCI was independently associated with longer door-to-balloon times, but revealed that it was no longer significantly associated with increased mortality.
"Our findings raise the question whether the development and implementation of national time targets for performing CT scanning before catheterization for STEMI could introduce measurable metrics that may encourage a more rapid CT scanning and primary PCI process," remark the authors.
They conclude: "Future studies should prospectively identify patient characteristics and presentations or which CT scans have the highest diagnostic utility in patients with possible STEMI."
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By Piriya Mahendra