What is the clinical evidence from this study?

Study design: Cohort. Population: Acute myocardial infarction (n=1451). Intervention: Door-to-wire (D2W) time vs. Shorter D2W time. Primary outcome: In-hospital mortality within 30 days of admission (HR 1.47, 95% CI 1.16-1.87, p=0.0016).

February 18, 2026Open Access

Association between door-to-wire time and 30-day mortality after PCI in patients with acute myocardial infarction: evidence from a single-center study in the China chest pain center registry

Key Result

Among patients with acute myocardial infarction undergoing percutaneous coronary intervention, each 10-minute increase in door-to-wire time was associated with a higher risk of 30-day mortality (HR 1.47).

Study Design

Type

Cohort (n=1,451)

Multicenter

Structured PICO

Does longer door-to-wire time increase 30-day in-hospital mortality in patients with acute myocardial infarction undergoing PCI?

Population

1,451 patients with confirmed acute myocardial infarction (1,015 STEMI, 436 NSTEMI) who underwent percutaneous coronary intervention (PCI) at a certified Chest Pain Center in China between January 2021 and April 2025.

Intervention

Door-to-wire (D2W) time analyzed as a continuous exposure (per 10-min increase) and categorized into early (≤90 min) and delayed (>90 min).

Comparator

Shorter door-to-wire time.

Outcome

In-hospital mortality within 30 days of admission.hard clinical

Longer door-to-wire time during PCI for acute myocardial infarction is nonlinearly associated with increased 30-day in-hospital mortality, with the lowest risk observed at approximately 50 minutes.

Main Result

Effect estimate: HR 1.47 (95% CI 1.16-1.87)

p-value: p=0.0016

Limitations

Retrospective, single-center study design limits generalizability and cannot rule out residual confounding.
In-hospital death within 30 days was relatively infrequent, which may affect the robustness of conclusions.
Door-to-wire time may be prone to measurement error and documentation variability.
Only captured in-hospital mortality within 30 days of admission and could not account for out-of-hospital deaths after discharge.
Evaluated multiple secondary outcomes which are susceptible to chance findings.

Abstract

Background: Door-to-wire (D2W) time may reflect the initiation of mechanical reperfusion in Acute myocardial infarction (AMI) more precisely. However, evidence on its association with short-term mortality remains limited, and the potential nonlinear or threshold relationship between D2W time and mortality has not been well characterized. This study aims to evaluate the association between D2W time and in-hospital mortality within 30 days and to explore potential nonlinear relationships. Methods: In this retrospective cohort study, we included patients with AMI who underwent percutaneous coronary intervention (PCI) at a certified Chest Pain Center in China between January 2021 and April 2025. The primary outcome was in-hospital mortality within 30 days of admission, and secondary outcomes included intraoperative and in-hospital complications. D2W time was analyzed as a continuous exposure (per 10-min increase). Multivariable Cox proportional hazards models with restricted cubic splines (RCS) were used to characterize potential nonlinear associations between D2W time and outcomes. RCS analyses were repeated in prespecified subgroups to assess robustness. Results: = 0.0016). RCS analyses suggested a nonlinear association, with the fitted curve reaching its lowest point at approximately 50 min and increasing thereafter. Longer D2W times were also associated with higher risks of in-hospital infection and respiratory failure. Findings were broadly consistent across prespecified subgroup analyses. Conclusion: Among patients with AMI undergoing PCI, longer D2W time was associated with higher risks of 30-day in-hospital mortality and in-hospital complications. RCS analyses suggested a nonlinear association between D2W time and 30-day in-hospital mortality, and further validation in future studies is needed.

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