Effect of door-to-balloon time on mortality in patients with ST-segment elevation myocardial infarction
Robert L McNamara1, Yongfei Wang, Jeph Herrin
1Department of Medicine, Section of Cardiovascular Medicine, Seattle, Washington, USA.
Insights
Shorter door-to-balloon times significantly reduce mortality in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). This association holds true across various patient risk profiles and symptom onset times.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- Conflicting study results exist regarding the relationship between door-to-balloon time and mortality in STEMI patients.
- Primary percutaneous coronary intervention (PCI) is a critical treatment for ST-segment elevation myocardial infarction (STEMI).
Purpose of the Study:
- To determine the impact of door-to-balloon time on mortality for STEMI patients receiving primary PCI.
- To analyze this relationship across different patient subgroups based on symptom onset and risk factors.
Main Methods:
- A cohort study of 29,222 STEMI patients treated with primary PCI within 6 hours of presentation.
- Data collected from the National Registry of Myocardial Infarction (NRMI)-3 and -4 (1999-2002).
- Hierarchical models used to assess door-to-balloon time's effect on in-hospital mortality, adjusted for patient characteristics.
Main Results:
- Longer door-to-balloon times were significantly associated with increased in-hospital mortality.
- Patients with door-to-balloon times >90 minutes had a 1.42 odds ratio for increased mortality compared to those with times ≤90 minutes.
- This association persisted regardless of symptom onset-to-door time or baseline mortality risk.
Conclusions:
- Door-to-balloon time is a critical determinant of mortality in STEMI patients undergoing primary PCI.
- Reducing door-to-balloon time is crucial for all STEMI patients, irrespective of symptom onset or baseline risk.
- Efforts to shorten PCI treatment times are vital for improving patient outcomes.
Objectives:
We sought to determine the effect of door-to-balloon time on mortality for patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).
Background:
Studies have found conflicting results regarding this relationship.
Methods:
We conducted a cohort study of 29,222 STEMI patients treated with PCI within 6 h of presentation at 395 hospitals that participated in the National Registry of Myocardial Infarction (NRMI)-3 and -4 from 1999 to 2002. We used hierarchical models to evaluate the effect of door-to-balloon time on in-hospital mortality adjusted for patient characteristics in the entire cohort and in different subgroups of patients based on symptom onset-to-door time and baseline risk status.
Results:
Longer door-to-balloon time was associated with increased in-hospital mortality (mortality rate of 3.0%, 4.2%, 5.7%, and 7.4% for door-to-balloon times of < or =90 min, 91 to 120 min, 121 to 150 min, and >150 min, respectively; p for trend <0.01). Adjusted for patient characteristics, patients with door-to-balloon time >90 min had increased mortality (odds ratio 1.42; 95% confidence interval [CI] 1.24 to 1.62) compared with those who had door-to-balloon time < or =90 min. In subgroup analyses, increasing mortality with increasing door-to-balloon time was seen regardless of symptom onset-to-door time (< or =1 h, >1 to 2 h, >2 h) and regardless of the presence or absence of high-risk factors.
Conclusions:
Time to primary PCI is strongly associated with mortality risk and is important regardless of time from symptom onset to presentation and regardless of baseline risk of mortality. Efforts to shorten door-to-balloon time should apply to all patients.
