Key result
Each 30-minute increase in door-to-balloon time was associated with a 30% increase in 180-day mortality and increased risk of ACS recurrence.
Why the study?
Current guidelines recommend a door to balloon time under 90 minutes for primary PCI, but relationships between D2B time and subsequent admissions for heart failure, ACS, and mortality required further examination.
Does shorter door to balloon time reduce mortality, ACS recurrence, and heart failure admissions in patients with STEMI undergoing primary PCI?
Cohort (n=826)
No
Does shorter door to balloon time reduce mortality, ACS recurrence, and heart failure admissions in patients with STEMI undergoing primary PCI?
Answers are grounded in this paper and cite their sources.
Shorter door-to-balloon times in primary PCI for STEMI are associated with significantly reduced mortality and ACS recurrence up to 1 year, reinforcing the critical importance of minimizing treatment delays.
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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Marcusohn et al. (2022) conducted a cohort in ST-elevation myocardial infarction (n=826). Door to balloon (D2B) time vs. Shorter D2B time was evaluated on Mortality at 180 days (per 30-minute increase in D2B time) (HR 1.308, 95% CI 1.046-1.635). Each 30-minute increase in door-to-balloon time was associated with a 30% increase in 180-day mortality and increased risk of ACS recurrence.
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