Door-to-Balloon Time and Clinical Outcome of Patients Presenting with ST-Segment Elevation Myocardial Infarction
Faisal Alkhadra1, Sarah Bohaligah2, Zahraa Alhashim2
1Emergency Medicine Department, Collage of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia.
Insights
Door-to-balloon time and off-hours presentation did not significantly impact ST-segment elevation myocardial infarction (STEMI) outcomes. Hypotension was the only complication linked to 30-day mortality in STEMI patients undergoing primary PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- Timely reperfusion is critical for ST-segment elevation myocardial infarction (STEMI) patients.
- Door-to-balloon (D2B) time is a key quality metric, but its impact during off-hours is unclear.
Purpose of the Study:
- To compare clinical outcomes and D2B times for STEMI patients presenting during off-hours versus on-hours.
- To evaluate the association between D2B time and clinical outcomes in STEMI patients.
Main Methods:
- A retrospective cohort study at King Fahad University Hospital, Saudi Arabia.
- Included 79 adult STEMI patients managed with primary percutaneous coronary intervention (PCI) from May 2023 to February 2024.
- Patients were categorized into on-hours and off-hours presentation groups.
Main Results:
- Off-hours presentation did not significantly affect mortality or complications compared to on-hours (p > 0.05).
- No significant association was found between D2B time and 48-hour or 30-day mortality (p > 0.05).
- Mean D2B time was significantly longer during off-hours (107.4 min) vs. on-hours (65.2 min) (p < 0.0001). Hypotension was significantly associated with 30-day mortality (p < 0.001).
Conclusions:
- Neither D2B time nor off-hours presentation significantly impacted STEMI mortality or complications after primary PCI.
- Hypotension emerged as a significant predictor of 30-day mortality in STEMI patients.
- Further research is needed to explore factors influencing STEMI outcomes beyond D2B time and presentation hours.
Background:
Timely reperfusion is crucial in patients with ST-segment elevation myocardial infarction (STEMI), with door-to-balloon time often considered a key metric for assessing quality of care. However, the impact of door-to-balloon time on clinical outcomes during off-hours remains uncertain.
Objective:
To compare clinical outcome and door-to-balloon time of patients with STEMI in off-hours versus on-hours in King Fahad Uni-versity Hospital (KFHU).
Methods:
A mixed-method, qualitative and quantitative retrospective cohort study was conducted at KFUH in Al Khobar, Saudi Arabia, including adults diagnosed with STEMI and managed with primary percutaneous coronary intervention (PCI) between May 2023 to February 2024. The sample was divided into two groups based on-duty hours. The first group comprised patients presenting during duty hours, including weekdays (Sunday to Thursday, 8 a.m. - 4 p.m.), while the second group included patients presenting during off-duty hours, which consisted of weekdays (Sunday to Thursday, 4:01 pm to 7:59 am), weekends (Friday to Saturday), national holidays, and Eid holidays.
Results:
The study included 79 patients (57 off-hours and 22 in-hours) diagnosed with STEMI who underwent primary PCI. The mean age of the participants was 55.0 years (±10.8), 89.9% were males, 36.7% were Saudi, and 41.8% were smokers. Off-hours presentation did not significantly impact mortality rates or complications compared to on-hours presentation (p > 0.05), Similarly, no significant association was found between door-to-balloon time and 48-hour or 30-day mortality rates (p > 0.05). The mean time was statistically significant across the on- and off-duty time groups (65.2±18.0 vs 107.4±44.5, p<0.0001). Hypotension was the only complication signifi-cantly associated with mortality at 30 days (p < 0.001).
Conclusion:
Our results revealed that neither door-to-balloon time nor off-hours presentation significantly affected mortality rates or complications in pa-tients with STEMI undergoing Primary PCI, with the exception of hypotension being significantly associat-ed with 30-day mortality. Further research is warranted to explore other factors that may influence STEMI outcomes beyond door-to-balloon time and presentation hours. Additionally, investigating the specific rela-tionship between hypotension and 30-day mortality could lead to improved risk stratification and manage-ment strategies for STEMI patients.
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