Key result
Primary PCI with DTB <60 minutes shows no benefit over ≥60 minutes for in-hospital outcomes.
Why the study?
While guidelines recommend door-to-balloon times under 90 minutes for STEMI patients undergoing primary PCI, the necessity of further reducing door-to-balloon time to less than 60 minutes remains debated.
Does primary PCI with door-to-balloon time < 60 min improve in-hospital outcomes compared to ≥ 60 min in acute STEMI patients?
Observational (n=531)
No
Does primary PCI with door-to-balloon time < 60 min improve in-hospital outcomes compared to ≥ 60 min in acute STEMI patients?
Absolute Event Rate: 0% vs 1.9%
p-value: p=>0.05
Reducing door-to-balloon time to less than 60 minutes did not significantly improve in-hospital outcomes compared to times of 60 minutes or more in STEMI patients undergoing primary PCI.
Non-significant mortality and morbidity differences with door-to-balloon <60 min should not change practice; leaves open whether further time reductions improve STEMI outcomes.
INTRODUCTION: Timely primary percutaneous coronary intervention (PCI) is crucial for optimal outcomes in STEMI patients, with guidelines recommending door-to-balloon time (DTB) of less than 90 min. Reducing DTB times may improve clinical outcomes, but the necessity of further reductions is debated. OBJECTIVE: Our study investigates the in-hospital outcomes of Acute STEMI patients with DTB of less than 60 min versus 60 or more minutes, aiming to determine whether further reducing DTB times is necessary. METHODS: A single-center prospective observational study was conducted from March 1 to September 30, 2023. The study included patients presenting with acute STEMI who underwent primary PCI within the specified time frame. Statistical analysis was performed using SPSS Version 20.0, with descriptive statistics and inferential tests (chi-square, independent sample t-test) used to analyse the data, considering a p < 0.05 as statistically significant. RESULTS: The study enrolled a total of 531 patients with Group-I (< 60 min) having 262 patients, and Group-II (>60 min) with 269 patients. The mean age was 52 years (90% males). Comorbidities, such as diabetes mellitus, smoking, hypertension, and family history of CAD, were similarly distributed between groups. In terms of outcomes, Group-I had better results, with 128 patients achieving TIMI-III flow, compared to 113 in Group-II. Group-I also had lower rates of myocardial infarction (0 vs. 2), shock (7 vs. 8), and heart failure (2 vs. 5). Notably, the mortality rate was 0 in Group-I, compared to 5 in Group-II, however all complications in terms of death or morbidity were statistically non-significant in both groups. Other outcomes, such as bleeding events, hematoma, and cerebrovascular accidents, were also low and similar between groups. CONCLUSIONS: The results showed that both groups had similar patient characteristics, including age, gender, and comorbidities, with adverse events, such as acute stent thrombosis, myocardial infarction, and mortality, were generally low and similar between groups.
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Zahidi et al. (2025) conducted an observational in Acute STEMI (n=531). Door-to-balloon time < 60 min vs. Door-to-balloon time ≥ 60 min was evaluated on In-hospital mortality (p=>0.05). Primary PCI with a door-to-balloon time <60 minutes compared to ≥60 minutes resulted in statistically non-significant differences in in-hospital mortality (0 vs 5 deaths) and morbidity.
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