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Background: Timely reperfusion therapy is recommended for patients with ST-segment elevation myocardial infarction (STEMI), and system delay <90 minutes and door-to-device (D2D) time <60 minutes are recommended by the 2017 ESC Guidelines for the management of STEMI patients and have been proposed as a performance measure for triaging patients for primary percutaneous coronary intervention (PCI). However, previous research produced contradictory results regarding the association between D2D time and mortality. Therefore, this study aimed to examine the associations between D2D time and mortality in Thailand. Methods: This cohort study included STEMI patients treated with primary PCI in 39 PCI centres in Thailand from February 27, 2018, to August 1, 2019. Patients were eligible if they met the following criteria: primary STEMI diagnosis, symptom onset within 12 hours, and ST-segment elevation of at least 0.1 mV in 2 or more contiguous leads (at least 0.2 mV in V1-V3) or a new left bundle branch block. Results: Within 12 hours of symptom onset, 3,874 patients underwent primary PCI. The median D2D time was 54 minutes [interquartile range (IQR) 29-90], and there was a significant difference between patients transferred from other hospitals (44 minutes, IQR 25-77, n=2,871) and patients presented directly to PCI centres (81 minutes, IQR 56-129, n=1,003) (P<0.001). Overall, in-hospital mortality was 7.8%. In a multivariable analysis, adjusting for other predictors of mortality and stratifying according to intervals of D2D time, cumulative in-hospital mortality was significantly higher in patients with a D2D time greater than 90 minutes [hazard ratio (HR) 1.5, 95% confidence interval (CI): 1.0-2.1, P=0.046] but not associated with D2D time shorter than 60 minutes (HR 1.2, 95% CI: 0.8-1.8, P=0.319). Conclusions: A D2D time greater than 90 minutes was related to in-hospital mortality in patients with STEMI treated with primary PCI, but a D2D time less than 60 minutes was not consistently associated with D2D time-improved survival in real-world, contemporary practice in Thailand.
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OBJECTIVE: To assess the efficacy and safety of transradial approach compared with transfemoral approach for coronary angiography and ad hoc angioplasty in Phramongkutklao hospital at the time of initiation of transradial program. MATERIAL AND METHOD: Prospective data collection of consecutive patients who underwent coronary angiography with ad hoc angioplasty during October 2004 to January 2005 was conducted. Baseline demographic data and the details of the procedure were recorded. The complications were assessed by a single doctor using standard protocol. RESULTS: There were 75 included in our study. Transradial approach and transfemoral approach was performed in 23 cases (30.7%) and 52 cases (69.3%), respectively. The baseline characteristics, procedure results were similar except the there was higher prevalence of NST-ACS symptoms (92.31% vs. 65.22%, p = 0.004) and access site complications in transfemoral group (23.08% vs. 4.35%, p = 0.035). The success rate was very high (> 90%) and not significantly different in both groups. However the transradial group was associated with lower assess site complications earlier ambulation and better patient's satisfaction. CONCLUSION: Even at the time of initiation of transradial program, transradial approach for coronary angiography and ad hoc angioplasty can be performed with similar efficacy, less local complication, earlier ambulation and better patient's satisfaction compared to the standard transfemoral approach.