Hospital Delays in Reperfusion for ST-Elevation Myocardial Infarction
Key result
Longer door-to-balloon minus door-to-needle times were associated with increased in-hospital mortality (P<0.0001), reducing the survival advantage of primary PCI over fibrinolysis.
Why the study?
Does increased door-to-balloon minus door-to-needle time reduce the survival advantage of primary PCI over fibrinolysis in patients with STEMI?
Population
192,509 patients with ST-segment elevation myocardial infarction from 645 National Registry of Myocardial…
Comparison
Primary percutaneous coronary intervention (PPCI) vs Fibrinolytic therapy
Design
Cohort
Follow-up
In-hospital
Authors
Discussion
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Implication
Supports delay-adjusted STEMI reperfusion decisions; hypothesis-generating and requires randomized confirmation before practice change.
Study Design
Type
Observational (n=192,509)
Multicenter
Yes
Structured PICO
Does increased door-to-balloon minus door-to-needle time reduce the survival advantage of primary PCI over fibrinolysis in patients with STEMI?
P
Population
192,509 patients with ST-segment elevation myocardial infarction from 645 hospitals in the National Registry of Myocardial Infarction.
E
Exposure
Primary percutaneous coronary intervention (PPCI)
C
Comparator
Fibrinolytic therapy
O
Outcome
In-hospital mortalityhard clinical
Main Result
p-value: p=<0.0001
The mortality advantage of primary PCI over fibrinolysis in STEMI is attenuated by treatment delays, emphasizing the need to consider both hospital PCI delays and patient characteristics when selecting a reperfusion strategy.
Cite This Study
Pinto et al. (2006) conducted an observational in ST-segment elevation myocardial infarction (n=192,509). Longer door-to-balloon minus door-to-needle (DB-DN) times vs. Shorter DB-DN times / Fibrinolysis was evaluated on In-hospital mortality (p=<0.0001). Longer door-to-balloon minus door-to-needle times were associated with increased in-hospital mortality (P<0.0001), reducing the survival advantage of primary PCI over fibrinolysis.