What is the clinical evidence from this study?

Study design: Cohort. Population: Acute Myocardial Infarction (n=2322). Intervention: Prolonged door-to-balloon time (≥2 hours) vs. Shorter door-to-balloon time (<2 hours). Primary outcome: Late mortality in high-risk patients (HR 1.53, 95% CI 1.22 to 1.90, p=0.0002).

What question did this study set out to answer?

This study aims to examine the relationship between door-to-balloon time and late cardiac mortality in patients with acute myocardial infarction.

August 9, 2026Journal of the American College of Cardiology236 citationsOpen Access

Door-to-Balloon Time With Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction Impacts Late Cardiac Mortality in High-Risk Patients and Patients Presenting Early After the Onset of Symptoms

Q: What are the key findings of this study?

Prolonged door-to-balloon times (≥2 hours) were associated with higher late mortality in high-risk patients (32.5% vs 21.5%; HR 1.53; 95% CI 1.22-1.90) and early presenters.

Q: What question did this study set out to answer?

This study aims to examine the relationship between door-to-balloon time and late cardiac mortality in patients with acute myocardial infarction.

BBBruce R. BrodieInterventional Cardiology CHCharles HansenCone Health TSThomas StuckeyInterventional Cardiology

Key Result

Prolonged door-to-balloon times (≥2 hours) were associated with higher late mortality in high-risk patients (32.5% vs 21.5%; HR 1.53; 95% CI 1.22-1.90) and early presenters.

Key Points

This study aims to examine the relationship between door-to-balloon time and late cardiac mortality in patients with acute myocardial infarction.
Analyzed outcomes in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction
Focused on high-risk patients and those presenting early after symptom onset
Evaluated mortality rates based on different door-to-balloon times.
Shorter door-to-balloon times correlate with reduced late cardiac mortality rates in high-risk patients
Early presentation of patients enhances survival outcomes
Statistically significant difference noted with p<0.05 for mortality outcomes.

Study Design

Type

Cohort (n=2,322)

Structured PICO

Does prolonged door-to-balloon time increase late cardiac mortality in patients undergoing primary PCI for acute myocardial infarction?

Population

2,322 consecutive patients treated with primary PCI for acute myocardial infarction, followed for a median of 83 months.

Exposure

Prolonged door-to-balloon time (≥2 hours, or categorized as 1.5-1.9 h, 2.0-2.9 h, ≥3.0 h)

Comparator

Shorter door-to-balloon time (<2 hours, or 0-1.4 h)

Outcome

Late cardiac mortality at 7 yearshard clinical

Delays in door-to-balloon time during primary PCI for acute myocardial infarction significantly increase late mortality, particularly in high-risk patients and those presenting early after symptom onset.

Main Result

Hazard Ratio: 1.53 (95% CI 1.22–1.9)

Absolute Event Rate: 32.5% vs 21.5%

p-value: p=0.0002

Abstract

OBJECTIVES: The purpose of this study was to evaluate the impact of door-to-balloon time with primary percutaneous coronary intervention (PCI) on late cardiac mortality. BACKGROUND: The impact of door-to-balloon time on outcomes is controversial, and the impact on late mortality has not been studied. METHODS: Consecutive patients (n = 2,322) treated with primary PCI from 1984 to 2003 were prospectively identified and followed up for a median of 83 months. RESULTS: Prolonged door-to-balloon times (0 to 1.4 h vs. 1.5 to 1.9 h vs. 2.0 to 2.9 h vs. > or =3.0 h) were associated with higher in-hospital mortality (4.9% vs. 6.1% vs. 8.0% vs. 12.2%, p or =2 h vs. 3 h) (21.1% vs. 18.5%; HR, 0.95; 95% CI, 0.62 to 1.45; p = 0.80). CONCLUSIONS: Delays in door-to-balloon time impact late survival in high-risk but not low-risk patients and in patients presenting early but not late after the onset of symptoms. These findings have implications for the triage of patients for primary PCI.

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