Contribution of First Contact With a Cardiologist to the Door-to-Cardiac Catheterization Laboratory Time in Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock ― Data From K-ACTIVE ―
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Current guidelines recommend early revascularization in patients with cardiogenic shock (CS) following acute myocardial infarction (AMI). However, guideline-recommended first medical contact-to-device times is reportedly achieved in only 40% of patients. METHODS AND RESULTS: We retrospectively analyzed 369 patients with AMI complicated by CS from the Kanagawa-Acute Cardiovascular Registry to evaluate factors influencing delays in treatment and their effect on in-hospital mortality. Patients were stratified into 2 groups based on the median door-to-cardiac catheterization laboratory (D2C) time (≤39 or >39 min). In the group with D2C time ≤39 min, the first-contact physician was more frequently a cardiologist (71.9% vs. 47.0%; P<0.001) and significantly more patients had chest pain as the chief complaint (70.3% vs. 47.4%; P<0.001). Although pre- and post-percutaneous coronary intervention Thrombolysis in Myocardial Infarction flow was similar between the 2 groups, in-hospital mortality was significantly lower in the D2C time ≤39 min group (18.8% vs. 37.6%; P<0.001). Multivariate logistic regression analysis revealed that D2C time >39 min was independently associated with a non-cardiologist being the first-contact physician, the absence of chest pain, a higher heart rate, and elevated creatinine levels. CONCLUSIONS: D2C time ≤39 min is correlated with reduced mortality in AMI patients with CS. Implementing systems to ensure cardiologists are the initial responders and optimizing in-hospital workflows could reduce the D2C time and improve outcomes.
Source: Circulation Journal
Institutions: Nippon Medical School Musashi Kosugi Hospital, Nippon Medical School, SHOWA Medical University Fujigaoka Hospital, St. Marianna University School of Medicine, Kitasato University, Tokai University, Yokohama City University Medical Center, Yokohama City University, Kanto Rosai Hospital, Kanagawa Cardiovascular and Respiratory Center, Yokohama Sakae Kyosai Hospital, Yokosuka City Hospital
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4414366241