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Published on: May 28, 2019
Door to balloon time in primary percutaneous coronary intervention in ST elevation myocardial infarction: every
Erez Marcusohn1, Anat Reiner Benaim2, Shay Ronen3
1Department of Cardiology, Rambam Health Care Campus, Haifa.
Insights
Shorter door-to-balloon (D2B) times significantly reduce mortality and acute coronary syndrome (ACS) recurrence in ST-elevation myocardial infarction patients. However, D2B time did not impact heart failure admissions within one year.
Area of Science:
- Cardiology
- Clinical Medicine
- Health Services Research
Background:
- Current guidelines recommend a 90-minute door-to-balloon (D2B) time for primary percutaneous coronary intervention (PPCI).
- Meeting this D2B goal is associated with reduced mortality and adverse cardiovascular events.
Purpose of the Study:
- To examine the relationship between D2B time and subsequent heart failure (HF) admissions, acute coronary syndrome (ACS) recurrence, and mortality.
- To evaluate the impact of D2B times on patient outcomes up to one year post-PPCI.
Main Methods:
- Retrospective analysis of 826 ST-elevation myocardial infarction patients undergoing PPCI from 2013-2019.
- Data collected included D2B time, clinical characteristics, and outcomes (HF, ACS, mortality).
- Multivariate Cox models were used to calculate adjusted hazard ratios (HR).
Main Results:
- No significant effect of D2B time on heart failure admissions was observed.
- Increased D2B time was associated with higher mortality at 180 days (HR 1.308 per 30-min increase).
- D2B time significantly impacted ACS recurrence, with a 30-minute cutoff showing increased recurrence up to 1 year.
Conclusions:
- Shorter D2B times correlate with reduced mortality and ACS recurrence.
- D2B time does not appear to influence the incidence of heart failure admissions.
- Optimizing D2B times remains crucial for improving outcomes in STEMI patients.
Objectives:
This study examines relationships between door to balloon (D2B) time and subsequent admissions due to heart failure (HF), acute coronary syndrome (ACS), and mortality for up to 1 year.
Background:
Current guidelines set 90-min for D2B time for primary percutaneous coronary intervention (PPCI) as a goal, which has been shown to reduce mortality and adverse events.
Methods:
Using the MDclone ADAMS system integrated with our electronic medical records, we conducted retrospective analysis of all patients admitted due to ST-elevation myocardial infarction from home, without any history of HF or coronary disease, and who underwent PPCI during 2013-2019. Data on D2B time, baseline clinical and demographic characteristics, and outcomes of HF, ACS and mortality were collected. Adjusted HR for each of the outcomes was calculated by multivariate Cox model.
Results:
A total of 826 patients were included in the final analysis. D2B had no significant effect on incidence of heart failure admissions for up to 1-year follow-up. D2B had a significant effect on mortality at 180 days, showing a 30% increase for each 30-min increase (HR 1.308; CI, 1.046-1.635) as for ACS at 90 days (HR 1.307; 1.025-1.638). The 30-min D2B cutoff showed a significant increase in ACS recurrence throughout the follow-up period at 90 days (HR 2.871, 1.239-6.648), 180 days (HR 2.607, 1.255-5.413), and 1 year (HR 1.886, 1.073-3.317).
Conclusions:
Patients with shorter D2B times had significantly reduced mortality and recurrence of ACS, with no effect on heart failure admission incidence.
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