Key result
A long door-to-balloon time (>120 minutes) was significantly associated with an increased risk of mid-term all-cause death compared to an intermediate time (60-120 minutes) (HR 2.80).
Why the study?
Door-to-balloon time is known to be associated with in-hospital death in STEMI, but little is known regarding its association with mid-term clinical outcomes.
Does a long door-to-balloon time increase mid-term all-cause death in STEMI patients undergoing primary PCI?
Cohort (n=309)
No
Does a long door-to-balloon time increase mid-term all-cause death in STEMI patients undergoing primary PCI?
Hazard Ratio: 2.8 (95% CI 1.26–6.17)
p-value: p=0.011
A door-to-balloon time exceeding 120 minutes is significantly associated with increased mid-term all-cause mortality in patients with STEMI undergoing primary PCI.
Supports targeting door-to-balloon times under 120 minutes; hypothesis-generating and requires prospective confirmation.
Objective In primary percutaneous coronary intervention (PCI), the door-to-balloon time (DTBT) is known to be associated with in-hospital death in patients with ST-segment elevation myocardial infarction (STEMI). However, little is known regarding the association between the DTBT and the mid-term clinical outcomes in patients with STEMI. The purpose of this study was to investigate the association between the DTBT and mid-term all-cause death. Methods The study population included 309 STEMI patients, who were divided into the short DTBT (DTBT<60 minutes, n=103), intermediate DTBT (DTBT 60-120 minutes, n=174) and long DTBT (DTBT >120 minutes, n=32) groups. The median follow-up period was 287 days (interquartile range: 182-624 days). Results The incidence of all-cause death in the long DTBT group was significantly higher in comparison to the other groups (p<0.001). In the multivariate Cox regression analysis, although a short DTBT [vs. intermediate DTBT: hazard ratio (HR) 1.00, 95% confidence interval (CI) 0.39-2.55, p=0.99] was not associated with all-cause death, a long DTBT (vs. intermediate DTBT: HR 2.80, 95% CI 1.26-6.17, p=0.011) was significantly associated with all-cause death, after controlling for confounding factors such as Killip class 4, an impaired renal function, and the number of diseased vessels. Conclusion The DTBT was significantly associated with the incidence of mid-term all-cause death. Our results support the strong adherence to the DTBT in patients with STEMI.
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Tsukui et al. (2020) conducted a cohort in ST-Segment Elevation Myocardial Infarction (STEMI) (n=309). Long door-to-balloon time (>120 minutes) vs. Intermediate door-to-balloon time (60-120 minutes) was evaluated on Mid-term all-cause death (HR 2.80, 95% CI 1.26-6.17, p=0.011). A long door-to-balloon time (>120 minutes) was significantly associated with an increased risk of mid-term all-cause death compared to an intermediate time (60-120 minutes) (HR 2.80).
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