Door-to-balloon time and mortality in patients with ST-elevation myocardial infarction undergoing primary angioplasty
Basheer Karkabi1, Gal Meir1, Barak Zafrir1
1Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, and the Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, 7 Michal St., Haifa, Israel.
Insights
A quality improvement intervention successfully reduced door-to-balloon times for ST-elevation myocardial infarction (STEMI) patients. While overall mortality remained unchanged, achieving faster treatment within 55 minutes was linked to a lower death rate.
Area of Science:
- Cardiology
- Healthcare Quality Improvement
Background:
- Door-to-balloon (D2B) time is a critical metric in ST-elevation myocardial infarction (STEMI) care.
- Previous quality improvement initiatives have focused on reducing D2B times.
- The direct impact of incremental D2B time increases on STEMI patient mortality remains under investigation.
Purpose of the Study:
- To evaluate the impact of a quality improvement intervention on D2B times in STEMI patients.
- To compare mortality rates in STEMI patients before and after the intervention.
- To assess the association between D2B time and patient outcomes.
Main Methods:
- Retrospective analysis of STEMI patient data.
- Comparison of D2B times and 30-day mortality rates before (n=133) and after (n=200) a quality improvement intervention.
- Statistical analysis including hazard ratio calculation for mortality based on D2B time.
Main Results:
- The quality improvement intervention significantly reduced the proportion of patients with D2B times exceeding 55 minutes (61% vs. 37%).
- Overall 30-day mortality rates did not differ significantly between the pre- and post-intervention groups.
- Patients treated within 55 minutes had a significantly lower 30-day mortality rate (2.8% vs. 9.7%) compared to those treated after 55 minutes.
Conclusions:
- The quality improvement intervention effectively reduced D2B times in STEMI patients.
- While overall mortality was not significantly affected, achieving D2B times within 55 minutes was associated with improved survival.
- Further research may be needed to elucidate the precise relationship between D2B time and mortality in STEMI.
Aims:
The evidence are not conclusive that a small incremental increase in door-to-balloon (D2B) time leads to a significant increase in death of ST-elevation myocardial infarction (STEMI) patients. In a previous study, we described a quality improvement intervention that reduced D2B time in 333 patients with STEMI. The aim of the current study was to compare mortality rates of the patients, before and after the intervention.
Methods And Results:
We examined the survival of 133 consecutive patients with STEMI treated prior to an intervention to decrease D2B time and 200 treated after the intervention. The mortality rate was the same before and after the quality intervention. The median D2B time for the entire cohort was 55 min. The number of patients with D2B time >55 min prior to the intervention was 82/133 (61%) and after the intervention 74/200 (37%) P < 0.00001. Thirty-day mortality among the patients with D2B time ≤55 min was 5/178 (2.8%) and among those with D2B time >55 min was 15/155 (9.7%), P < 0.008. The hazard ratio for 30-day mortality when the D2B time was >55 min was 3.7 (1.3-10.4).
Conclusion:
Mortality and non-fatal complications did not differ significantly between STEMI patients before and after a quality improvement intervention. However, the number of patients treated within 55 min from arrival was significantly higher after the intervention; and coronary intervention within this time was associated with a lower death rate.
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