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Coronary intervention door-to-balloon time and outcomes in ST-elevation myocardial infarction: a meta-analysis

Chee Yoong Foo1,2,3, Kwadwo Osei Bonsu3,4,5, Brahmajee K Nallamothu6,7

  • 1National Clinical Research Centre, Kuala Lumpur, Malaysia.

Heart (British Cardiac Society)
|February 14, 2018
PubMed

Insights

Longer door-to-balloon delays in ST-elevation myocardial infarction (MI) increase mortality risk. Prehospital delays significantly modify this association, highlighting the importance of timely treatment for better patient outcomes.

Area of Science:

  • Cardiology
  • Public Health

Background:

  • ST-elevation myocardial infarction (MI) is a critical cardiovascular event.
  • Timely reperfusion therapy, such as primary percutaneous coronary intervention (PCI), is crucial for improving MI outcomes.
  • Door-to-balloon (D2B) delay is a key metric for assessing the efficiency of primary PCI.

Purpose of the Study:

  • To determine the relationship between D2B delay in primary PCI and ST-elevation MI outcomes.
  • To examine potential effect modifiers, such as prehospital delays, on this relationship.

Main Methods:

  • Systematic review and meta-analysis of prospective observational studies.
  • Included studies investigated the association between D2B delay and clinical outcomes, primarily mortality and heart failure.
  • Quantitative reporting based on data from 32 studies involving 299,320 patients.

Main Results:

  • Longer D2B delays (>90 minutes) were associated with a significantly higher risk of both short-term (OR 1.52) and medium- to long-term mortality (OR 1.53).
  • A non-linear time-risk relationship was observed (P=0.004).
  • Prehospital delays modified the association between D2B delay and short-term mortality, with a stronger effect in patients with shorter prehospital delays.

Conclusions:

  • Extended D2B delays in primary PCI for ST-elevation MI are linked to increased adverse outcomes.
  • Prehospital delays are significant effect modifiers.
  • The non-linear time-risk association may explain population-level outcome trends despite D2B time improvements.
Abstract

Keywords:
door-to-balloon timemeta-analysismyocardial infarctionpre-hospital delaysprimary percutaneous coronary interventionreperfusion timeliness

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