Effect of Shorter Door-to-Balloon Times Over 20 Years on Outcomes of Patients With Anterior ST-Elevation Myocardial
Amgad Mentias1, Mohammad Q Raza1, Amr F Barakat1
1Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Insights
Outcomes for anterior ST-elevation myocardial infarction (STEMI) improved significantly between 1995 and 2014, with shorter door-to-balloon times (DBT) strongly linked to better long-term survival. This study highlights advancements in treating this critical heart condition.
Area of Science:
- Cardiology
- Public Health
Background:
- Cardiovascular disease is a leading cause of mortality globally.
- Anterior ST-elevation myocardial infarction (STEMI) is a severe form of heart attack with significant implications for patient outcomes.
- Improvements in treatment protocols and patient care over time are crucial for reducing mortality associated with STEMI.
Purpose of the Study:
- To evaluate the changes in clinical outcomes for patients with anterior STEMI over a 20-year period (1995-2014).
- To assess the impact of primary percutaneous coronary intervention (PCI) timing on long-term mortality in anterior STEMI patients.
- To identify trends in patient demographics and comorbidities over the study period.
Main Methods:
- A retrospective analysis of 1,658 patients with anterior STEMI who underwent primary PCI within 12 hours of presentation.
- Patients were divided into four quartiles based on presentation year (1995-1999, 2000-2004, 2005-2009, 2010-2014).
- Outcomes analyzed included changes in age, prevalence of risk factors (smoking, hypertension, obesity), length of hospital stay, door-to-balloon time (DBT), and short-term and long-term mortality rates. Statistical adjustments were made for various clinical factors.
Main Results:
- Mean patient age decreased over time, while the prevalence of smoking, hypertension, and obesity increased.
- Median length of hospital stay and median door-to-balloon time (DBT) significantly decreased across the quartiles.
- Thirty-day, 1-year, and 3-year mortality rates showed significant improvement over the two decades. Shorter DBT was independently associated with lower long-term mortality.
Conclusions:
- Long-term outcomes for patients with anterior STEMI have substantially improved over the past two decades.
- The reduction in door-to-balloon time (DBT) is a key factor contributing to improved survival rates.
- Despite increasing prevalence of risk factors, advancements in primary PCI have led to better patient prognoses in anterior STEMI.
Abstract:
Cardiovascular disease remains the most common cause of mortality. We studied the change in outcomes for anterior ST-elevation myocardial infarction (STEMI) between 1995 and 2014. Over the past 20 years, 1,658 patients presenting to our center with anterior STEMI underwent primary percutaneous coronary intervention within 12 hours of presentation. We divided these into 4 quartiles, 1995 to 1999 (n = 312), 2000 to 2004 (n = 408), 2005 to 2009 (n = 428), and 2010 to 2014 (n = 510). Across the 4 quartiles, mean age decreased (64.4, 62, 60.3, and 60 years, p <0.01). In all groups, there was a significant rise in prevalence of smoking, hypertension, and obesity. The median length of hospital stay decreased (6, 4.4, 4.2, and 3.6 days, p <0.01), as did the median door-to-balloon time (DBT) (217, 194, 135, and 38 minutes, p <0.01). Thirty-day and 1-year mortality improved over time (14.4%, 11.8%, 8.4%, and 7.8%; and 20.5%, 16.4%, 15.9%, and 13.9%) (p = 0.01 both). Also, 3-year mortality improved (25.3%, 21.6%, 21.3%, and 16.5%, p = 0.02). After adjusting for age, gender, co-morbidities, ejection fraction, clinical shock, and mitral regurgitation, shorter DBT was associated with lower long-term mortality (compared with DBT <60 minutes; 60 to 90 minutes hazard ratio [HR] 1.67, 95% confidence interval [CI] 0.93 to 3.00, p = 0.084; 90 to 120 minutes, HR 1.74, 95% CI 1.02 to 2.95, p = 0.04; >120 minutes, HR 1.91, 95% CI 1.23 to 2.96, p = 0.004). In conclusion, over the past 2 decades, long-term outcomes improved in patients presenting with anterior STEMI associated with shortening of DBT.
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