Association between door-to-balloon time ≤60 minutes and short- and long-term outcomes in patients with ST-segment
Zichen Wang1,2, Zhaofeng Wang1, Xuehan Zhi3
1State Key Laboratory of Frigid Zone Cardiovascular Disease, Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theatre Command, Shenyang, Liaoning, China.
Background:
Current guidelines diverge on the optimal door-to-balloon time (DTBT) for acute ST-segment elevation myocardial infarction (STEMI), and whether a ≤60 min target benefits all patients equally remains unclear.
Objectives:
This study aimed to investigate whether the association between DTBT ≤60 min and short- and long-term prognosis in STEMI patients varies by Global Registry of Acute Coronary Events (GRACE) risk score.
Design:
Retrospective cohort study.
Setting:
Single high-volume tertiary cardiology centre in China.
Participants:
This study initially included 5516 STEMI patients undergoing primary percutaneous coronary intervention (PPCI) treatment. 4513 were included after applying inclusion criteria (age >18 years, presentation within 12 hours of symptom onset, complete medical records) and exclusion criteria (symptom duration ≥12 hours, failure to receive PPCI, incomplete outcome data).
Interventions:
Not applicable (observational study).
Primary And Secondary Outcome Measures:
The primary outcomes were in-hospital, 1-year and 3-year all-cause mortality. Secondary outcomes included major adverse cardiovascular and cerebrovascular events (MACCE) at 1 and 3 years post-discharge.
Results:
Among 4513 STEMI patients, 2433 (54.0%) were high-risk (HR-STEMI) and 2080 (46.0%) low-risk (LR-STEMI). DTBT ≤60 min was achieved in 45.7% of HR-STEMI and 52.0% of LR-STEMI patients. For HR-STEMI patients, DTBT >60 min was associated with significantly higher risks of in-hospital mortality (OR=2.381, 95% CI 1.160 to 4.883, p=0.018), 1-year mortality (HR=1.715, 95% CI 1.194 to 2.464, p=0.003), 1-year MACCE (HR=1.212, 95% CI 1.001 to 1.467, p=0.049), 3-year mortality (HR=1.689, 95% CI 1.267 to 2.253, p<0.001), and 3-year MACCE (HR=1.230, 95% CI 1.042 to 1.453, p=0.014). Among LR-STEMI patients, no significant differences were observed between DTBT groups.
Conclusions:
DTBT ≤60 min was significantly associated with better short- and long-term outcomes, particularly in patients with GRACE >140. Sensitivity analysis suggested that the benefit may also extend to patients with GRACE scores between 120 and 140.
Trial Registration Number:
Not applicable (observational study).
